Healthcare Provider Details

I. General information

NPI: 1003265299
Provider Name (Legal Business Name): ANNE CHRISTINE RIVERA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 1ST ST 49MDG/SGPZ
HOLLOMAN AFB NM
88330-8273
US

IV. Provider business mailing address

280 1ST ST 49MDG/SGPZ
HOLLOMAN AFB NM
88330-8273
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-6047
  • Fax: 575-572-2259
Mailing address:
  • Phone: 575-572-6047
  • Fax: 575-572-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: