Provider Demographics
NPI:1154119063
Name:RIVERA, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:RIVERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-6945
Mailing Address - Country:US
Mailing Address - Phone:405-201-2869
Mailing Address - Fax:
Practice Address - Street 1:320 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5238
Practice Address - Country:US
Practice Address - Phone:405-573-3819
Practice Address - Fax:405-701-6683
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator