Provider Demographics
NPI:1154589521
Name:RIVERA, LIZZETTE (SP)
Entity type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 BROCK ST
Mailing Address - Street 2:STE B
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3257
Mailing Address - Country:US
Mailing Address - Phone:956-583-7752
Mailing Address - Fax:956-583-7793
Practice Address - Street 1:2402 BROCK ST
Practice Address - Street 2:STE B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3257
Practice Address - Country:US
Practice Address - Phone:956-583-7752
Practice Address - Fax:956-583-7793
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist