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General NPI Number Information
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NPI Number | 1417745530
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Entity Type | Individual
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Provider Name | DESTINY RENEE RIVERA ATC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 3895 HARRISON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-2312
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Country | US
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Telephone | 801-387-7678
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Fax |
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Provider Business Mailing Address
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Address Line | 4250 S 1000 W APT 52
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City | RIVERDALE
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State | UT
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Zip | 84405-3333
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 13993992-4810
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License Number State | UT
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