Provider Demographics
NPI:1063380616
Name:RIVERA-LEAL, CARMINA
Entity type:Individual
Prefix:
First Name:CARMINA
Middle Name:
Last Name:RIVERA-LEAL
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 1:8324 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4161
Mailing Address - Country:US
Mailing Address - Phone:907-947-7691
Mailing Address - Fax:
Practice Address - Street 1:8324 WILCOX ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4161
Practice Address - Country:US
Practice Address - Phone:907-947-7691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102074310400000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No374U00000XNursing Service Related ProvidersHome Health Aide