Healthcare Provider Details

I. General information

NPI: 1730458472
Provider Name (Legal Business Name): ELSA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 W 120TH AVE SUITE 100
WESTMINSTER CO
80020-3307
US

IV. Provider business mailing address

1027 E 9TH AVE APT 101
BROOMFIELD CO
80020-1554
US

V. Phone/Fax

Practice location:
  • Phone: 303-451-6706
  • Fax:
Mailing address:
  • Phone: 303-718-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12787
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: