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General NPI Number Information
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NPI Number | 1053547893
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Entity Type | Individual
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Provider Name | CARLA RENEE RIVERA DPT
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Gender | Female
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 1029 KAPAHULU AVE STE 401
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City | HONOLULU
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State | HI
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Zip | 96816-1332
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Country | US
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Telephone | 410-831-3226
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Fax | 410-677-0883
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Provider Business Mailing Address
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Address Line | P.O. BOX 10327
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City | HONOLULU
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State | HI
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Zip | 96816-0327
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Country | US
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Telephone | 808-739-1977
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Fax | 808-739-1979
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5197
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License Number State | HI
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