MEDICARE: MRS. BLANCA ESTELA RIVERA LBSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	38331	TX

General Provider Information

NPI Number	:	1487703062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BLANCA ESTELA RIVERA LBSW

Provider Business Mailing Address
First Line	:	2029 E 27TH ST
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78574-2008
Country	:	US
Telephone Number	:	956-583-1854
Fax Number	:	956-583-6386

Provider Business Practice Location Address
First Line	:	2029 E 27TH ST
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78574-2008
Country	:	US
Telephone Number	:	956-583-1854
Fax Number	:	956-583-6386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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