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NPI Code Detail

MEDICARE: THAIS RIVERA GONZALEZ

MEDICARE:   THAIS  RIVERA GONZALEZ
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
1163W00000XRegistered NurseRN2346668MA

General Provider Information

NPI Number : 1578290235
Entity Type Code : Individual
Provider Name (Legal Business Name) : THAIS RIVERA GONZALEZ
Provider Business Mailing Address
First Line : PO BOX 791
Second Line :
City : HOLYOKE
State : MA
Zip : 01041-0791
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 152 CENTER ST
Second Line :
City : CHICOPEE
State : MA
Zip : 01013-1611
Country : US
Telephone Number : 413-540-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2022
Last Update Date : 08/03/2022

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Directions to “ THAIS RIVERA GONZALEZ ” Practice Location

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