MEDICARE: GRACE G RIBERA

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1467746008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE G RIBERA

Provider Business Mailing Address
First Line	:	2831 SAINT ROSE PKWY FL 2
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4840
Country	:	US
Telephone Number	:	702-540-9534
Fax Number	:	702-589-4866

Provider Business Practice Location Address
First Line	:	2831 SAINT ROSE PKWY FL 2
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4840
Country	:	US
Telephone Number	:	702-540-9534
Fax Number	:	702-589-4866

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

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	05/31/2011

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Directions to “ GRACE G RIBERA ” Practice Location

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