Provider Demographics
NPI:1700148376
Name:RIVERA, LUZ
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12160 6TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1105
Mailing Address - Country:US
Mailing Address - Phone:718-779-8800
Mailing Address - Fax:718-779-2070
Practice Address - Street 1:8823 31ST AVE
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1437
Practice Address - Country:US
Practice Address - Phone:718-779-8800
Practice Address - Fax:718-779-2070
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator