MEDICARE: CARLA 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	163WH0200X	Home Health Registered Nurse	830140	NY

General Provider Information

NPI Number	:	1871441253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA RIVERA

Provider Business Mailing Address
First Line	:	203 REGIS DR # 1
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1423
Country	:	US
Telephone Number	:	347-522-6814
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 REGIS DR # 1
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1423
Country	:	US
Telephone Number	:	347-522-6814
Fax Number	:

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

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ CARLA RIVERA ” Practice Location

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