Healthcare Provider Details

I. General information

NPI: 1033360938
Provider Name (Legal Business Name): MONICA M RIVERA CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 01/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 CARRICKTON CIR
ORLANDO FL
32824-4217
US

IV. Provider business mailing address

PO BOX 941274
MAITLAND FL
32794-1274
US

V. Phone/Fax

Practice location:
  • Phone: 703-304-3912
  • Fax:
Mailing address:
  • Phone: 888-322-6432
  • Fax: 888-329-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: