Healthcare Provider Details

I. General information

NPI: 1932347978
Provider Name (Legal Business Name): ROSA RIVERA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 RIVERSIDE DR APT 2E
NEW YORK NY
10032-7457
US

IV. Provider business mailing address

610 W 158TH ST 2ND FLOOR
NEW YORK NY
10032-7104
US

V. Phone/Fax

Practice location:
  • Phone: 212-234-6038
  • Fax:
Mailing address:
  • Phone: 212-544-1879
  • Fax: 212-544-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number491045-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: