Healthcare Provider Details

I. General information

NPI: 1700539103
Provider Name (Legal Business Name): IRIS LEE RIVERA CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 4TH ST
ROBSTOWN TX
78380-2743
US

IV. Provider business mailing address

601 N 4TH ST
ROBSTOWN TX
78380-2743
US

V. Phone/Fax

Practice location:
  • Phone: 361-442-6498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number206046
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: