MEDICARE: MISS LIZETTE G 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1871923763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LIZETTE G RIVERA

Provider Business Mailing Address
First Line	:	3870 WALNUT RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115
Country	:	US
Telephone Number	:	702-241-1070
Fax Number	:

Provider Business Practice Location Address
First Line	:	3870 N WALNUT RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-0323
Country	:	US
Telephone Number	:	702-241-1070
Fax Number	:

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

Provider Enumeration Date	:	11/14/2013
Last Update Date	:	11/14/2013

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Directions to “ MISS LIZETTE G RIVERA ” Practice Location

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