1366427395 NPI number — DR. LISA KATHERINE RIVERA D.O.

Table of content: KENDRA THOMPSON RBT (NPI 1841825650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366427395 NPI number — DR. LISA KATHERINE RIVERA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
LISA
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366427395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92-243 HOALII PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAPOLEI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96707-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-218-6823
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 MOFFET ST, BLDG 4077
Provider Second Line Business Practice Location Address:
JOINT BASE PEARL HARBOR-HICKAM
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96853-5168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-448-4500
Provider Business Practice Location Address Fax Number:
808-448-4589
Provider Enumeration Date:
12/13/2005

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: 207ZF0201X , with the licence number:  02002823A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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