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General NPI Number Information
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NPI Number | 1154504546
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Entity Type | Individual
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Provider Name | DAVID RIVERA MA
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Gender | Male
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 2452 PINE CHASE CIR
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6500
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Country | US
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Telephone | 407-738-6230
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Fax | 800-580-7167
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Provider Business Mailing Address
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Address Line | 2452 PINE CHASE CIR
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6500
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Country | US
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Telephone | 407-738-6230
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Fax | 800-580-7167
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA44696
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License Number State | FL
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