Healthcare Provider Details

I. General information

NPI: 1558538512
Provider Name (Legal Business Name): MRS. ANA L RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MONTANA AVE
SAINT CLOUD FL
34769-3582
US

IV. Provider business mailing address

1100 MONTANA AVE
SAINT CLOUD FL
34769-3582
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-1256
  • Fax: 407-892-1928
Mailing address:
  • Phone: 407-892-1256
  • Fax: 407-892-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberSU28393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: