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General NPI Number Information
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NPI Number | 1235705336
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Entity Type | Individual
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Provider Name | LISA LOUISE RIVERA CM61165804
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Gender | Female
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 201 HIGHLAND DR
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City | BUENA
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State | WA
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Zip | 98921-0139
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Country | US
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Telephone | 509-865-6705
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 BROWNE AVE APT 9
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City | YAKIMA
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State | WA
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Zip | 98902-3054
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Country | US
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Telephone | 509-881-5307
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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 | 2470A2800X
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Taxonomy Name | Assistant Health Information Record Technician
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License Number | CM61165804
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License Number State | WA
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