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NPI Code Detail

MEDICARE: MR. ENRIQUE RIVERA JR. RN

MEDICARE: MR. ENRIQUE RIVERA JR. RN
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
1163WC0400XCase Management Registered Nurse17197PR

General Provider Information

NPI Number : 1548840424
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ENRIQUE RIVERA JR. RN
Provider Business Mailing Address
First Line : 126 MILLSTREAM TER
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80905-4430
Country : US
Telephone Number : 719-619-7550
Fax Number :
Provider Business Practice Location Address
First Line : 1665 COCHRANE CIR BLDG 7494
Second Line :
City : FT CARSON
State : CO
Zip : 80913-4603
Country : US
Telephone Number : 719-524-2645
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2021
Last Update Date : 04/13/2021

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