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General NPI Number Information
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NPI Number | 1780226449
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Entity Type | Individual
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Provider Name | LEEVETTE RIVERA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 2165 DIXWELL AVE
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City | HAMDEN
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State | CT
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Zip | 06514-2116
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Country | US
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Telephone | 203-248-2727
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Fax | 203-691-9673
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Provider Business Mailing Address
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Address Line | 2165 DIXWELL AVE
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City | HAMDEN
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State | CT
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Zip | 06514-2116
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Country | US
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Telephone | 203-248-2727
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Fax | 203-691-9673
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4649
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4649
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License Number State | CT
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