MEDICARE: DOMINIQUE MARIE 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1891586319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE MARIE RIVERA

Provider Business Mailing Address
First Line	:	6608 JOHNNY LOVE LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1367
Country	:	US
Telephone Number	:	702-403-5095
Fax Number	:

Provider Business Practice Location Address
First Line	:	6608 JOHNNY LOVE LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1367
Country	:	US
Telephone Number	:	702-403-5095
Fax Number	:

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	05/14/2025

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Directions to “ DOMINIQUE MARIE RIVERA ” Practice Location

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