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General NPI Number Information
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NPI Number | 1134782949
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Entity Type | Individual
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Provider Name | ANDREA RIVERA L.AC., LMT
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Gender | Female
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 1852 SOUTH AVE W
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City | MISSOULA
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State | MT
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Zip | 59801-6510
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Country | US
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Telephone | 808-341-4349
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Fax |
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Provider Business Mailing Address
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Address Line | 700 MARSHALL ST
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City | MISSOULA
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State | MT
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Zip | 59801-3616
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Country | US
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Telephone |
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | MED-ACU-LIC-51581
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License Number State | MT
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