Healthcare Provider Details

I. General information

NPI: 1114572443
Provider Name (Legal Business Name): ANTHONY STUART RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2019
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 W CHARLESTON BLVD STE 111
LAS VEGAS NV
89146-1067
US

IV. Provider business mailing address

6505 HYDE AVE
LAS VEGAS NV
89107-2408
US

V. Phone/Fax

Practice location:
  • Phone: 702-763-7443
  • Fax:
Mailing address:
  • Phone: 725-267-7494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC-2301
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: