Provider Demographics
NPI:1124697461
Name:RIVERA, CARLOS FRANCISCO
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:FRANCISCO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2672 E BLUE SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-3420
Mailing Address - Country:US
Mailing Address - Phone:928-276-2307
Mailing Address - Fax:
Practice Address - Street 1:2672 E BLUE SPRUCE LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-3420
Practice Address - Country:US
Practice Address - Phone:928-276-2307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA127682355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant