Healthcare Provider Details

I. General information

NPI: 1154756278
Provider Name (Legal Business Name): MRS. AILEEN RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BUFORD RD
NORTH CHESTERFIELD VA
23235-5292
US

IV. Provider business mailing address

1200 DOTSON RD
RICHMOND VA
23231-6713
US

V. Phone/Fax

Practice location:
  • Phone: 804-768-7205
  • Fax:
Mailing address:
  • Phone: 804-402-5589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: