MEDICARE: NAHIR COLON RIVERA LAC

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	171100000X	Acupuncturist	AP4572	FL

General Provider Information

NPI Number	:	1225878606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAHIR COLON RIVERA LAC

Provider Business Mailing Address
First Line	:	19379 LONG LAKE RANCH BLVD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-5513
Country	:	US
Telephone Number	:	813-576-8064
Fax Number	:

Provider Business Practice Location Address
First Line	:	19379 LONG LAKE RANCH BLVD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-5513
Country	:	US
Telephone Number	:	813-576-8064
Fax Number	:

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

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	05/31/2024

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