Healthcare Provider Details

I. General information

NPI: 1487181541
Provider Name (Legal Business Name): ALEJANDRA NATHALIE RIVERA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10909 W LINEBAUGH AVE STE 102
TAMPA FL
33626-1741
US

IV. Provider business mailing address

10909 W LINEBAUGH AVE STE 102
TAMPA FL
33626-1741
US

V. Phone/Fax

Practice location:
  • Phone: 813-774-6003
  • Fax:
Mailing address:
  • Phone: 813-774-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number100148515
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN23280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: