Healthcare Provider Details

I. General information

NPI: 1992695332
Provider Name (Legal Business Name): JORGELINA RIVERA SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 RICHMOND AVE N
LEHIGH ACRES FL
33972-2913
US

IV. Provider business mailing address

815 RICHMOND AVE N
LEHIGH ACRES FL
33972-2913
US

V. Phone/Fax

Practice location:
  • Phone: 239-600-5716
  • Fax:
Mailing address:
  • Phone: 239-600-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number25-307
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: