Healthcare Provider Details

I. General information

NPI: 1891536231
Provider Name (Legal Business Name): ANNDRYA RIVERA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 SAN PEDRO DR NE BLDG B1
ALBUQUERQUE NM
87110-8903
US

IV. Provider business mailing address

1600 TIERRA ALTA CT NW
LOS LUNAS NM
87031-8190
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-7600
  • Fax: 505-344-2104
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0292
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: