Provider Demographics
NPI:1831634427
Name:RIVERA, ANGELI DEVORA
Entity type:Individual
Prefix:
First Name:ANGELI
Middle Name:DEVORA
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 1:25 ARLINGTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4318
Mailing Address - Country:US
Mailing Address - Phone:774-329-9387
Mailing Address - Fax:
Practice Address - Street 1:25 ARLINGTON ST APT 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4318
Practice Address - Country:US
Practice Address - Phone:774-329-9387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1000021113822Medicaid