Provider Demographics
NPI:1538937412
Name:RIVERA CONTRERAS, KATHERINE ANDREA (SA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANDREA
Last Name:RIVERA CONTRERAS
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10104 LANCEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2368
Mailing Address - Country:US
Mailing Address - Phone:502-531-5012
Mailing Address - Fax:
Practice Address - Street 1:10104 LANCEWOOD RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2368
Practice Address - Country:US
Practice Address - Phone:502-531-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
23-747246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant