Healthcare Provider Details

I. General information

NPI: 1760228951
Provider Name (Legal Business Name): JAVIER RIVERA-REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11935 ABERCORN ST
SAVANNAH GA
31419-1918
US

IV. Provider business mailing address

10677 CAMARILLA CT
DULUTH GA
30097-8494
US

V. Phone/Fax

Practice location:
  • Phone: 912-344-3109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: