MEDICARE: GERARDO RIVERA PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	633985	TX

General Provider Information

NPI Number	:	1730456484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO RIVERA PMHNP

Provider Business Mailing Address
First Line	:	511 ARBOR CT
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-8135
Country	:	US
Telephone Number	:	832-235-7247
Fax Number	:

Provider Business Practice Location Address
First Line	:	5156 BUFFALO SPEEDWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77584
Country	:	US
Telephone Number	:	713-218-7825
Fax Number	:

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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