1699822445 NPI number — ALICIA A RIVERA D.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699822445 NPI number — ALICIA A RIVERA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
ALICIA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARDOZE
Provider Other First Name:
ALICIA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699822445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
821 DEBARY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELTONA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32725-8805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-860-5448
Provider Business Mailing Address Fax Number:
386-668-3665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 DEBARY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELTONA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32725-8805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-860-5448
Provider Business Practice Location Address Fax Number:
386-668-3665
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH7903 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 316158 . This is a "CHIRO ALLIANCE CORP." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 381780600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6265773 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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