Healthcare Provider Details

I. General information

NPI: 1932566825
Provider Name (Legal Business Name): TONYA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TONYA RIVERA BACHELORS

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S ORANGE BLOSSOM TRL 261
ORLANDO FL
32805-3118
US

IV. Provider business mailing address

146 GRAND JUNCTION BLVD
ORLANDO FL
32835-1253
US

V. Phone/Fax

Practice location:
  • Phone: 407-270-6685
  • Fax: 407-270-6686
Mailing address:
  • Phone: 407-209-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: