MEDICARE: MARKETTA RIVERA

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1760193973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARKETTA RIVERA

Provider Business Mailing Address
First Line	:	4904 CAMINO AL NORTE UNIT 337771
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89033-8931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6124 WARM RIVER RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1757
Country	:	US
Telephone Number	:	317-984-0325
Fax Number	:

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

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	12/08/2022

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Directions to “ MARKETTA RIVERA ” Practice Location

Language	Start Address	Practice Location

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