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General NPI Number Information
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NPI Number | 1770073512
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Entity Type | Individual
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Provider Name | ALEXANDER RIVERA
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Gender | Male
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 4600 SW 46TH CT STE 140
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City | OCALA
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State | FL
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Zip | 34474-5785
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Country | US
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Telephone | 352-873-3058
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Fax |
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Provider Business Mailing Address
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Address Line | 1851 N LOURDES TER
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City | INVERNESS
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State | FL
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Zip | 34453-9523
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Country | US
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Telephone | 860-729-9626
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA87788
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License Number State | FL
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