Healthcare Provider Details

I. General information

NPI: 1932919859
Provider Name (Legal Business Name): ALEJANDRO RIVERA MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 TOPAZ DR
LOVELAND CO
80537-3210
US

IV. Provider business mailing address

446 E 29TH ST UNIT 1434
LOVELAND CO
80539-4066
US

V. Phone/Fax

Practice location:
  • Phone: 970-593-0125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: