MEDICARE: MRS. CARMEN LUZ RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle
2	172A00000X	Driver

General Provider Information

NPI Number	:	1194510511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN LUZ RIVERA

Provider Business Mailing Address
First Line	:	1435 W 54TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3319
Country	:	US
Telephone Number	:	216-407-4534
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 W 54TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3319
Country	:	US
Telephone Number	:	216-407-4534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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Directions to “ MRS. CARMEN LUZ RIVERA ” Practice Location

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