Healthcare Provider Details

I. General information

NPI: 1477474815
Provider Name (Legal Business Name): ROMAN RIVERA CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 HIGHWAY 61
STERLING CO
80751-8902
US

IV. Provider business mailing address

12220 HIGHWAY 61
STERLING CO
80751-8902
US

V. Phone/Fax

Practice location:
  • Phone: 970-522-7383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0021247
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: