Healthcare Provider Details

I. General information

NPI: 1053547893
Provider Name (Legal Business Name): CARLA RENEE RIVERA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 KAPAHULU AVE STE 401
HONOLULU HI
96816-1332
US

IV. Provider business mailing address

P.O. BOX 10327
HONOLULU HI
96816-0327
US

V. Phone/Fax

Practice location:
  • Phone: 410-831-3226
  • Fax: 410-677-0883
Mailing address:
  • Phone: 808-739-1977
  • Fax: 808-739-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5197
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: