Healthcare Provider Details

I. General information

NPI: 1902468549
Provider Name (Legal Business Name): NANCY V RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 S AVENUE B STE 2504
YUMA AZ
85364-7758
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7170
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-1897
  • Fax: 928-336-1898
Mailing address:
  • Phone: 928-336-1802
  • Fax: 928-336-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: