Provider Demographics
NPI:1154891620
Name:RIVERA, VALENTINA KRASTEVA
Entity type:Individual
Prefix:MRS
First Name:VALENTINA
Middle Name:KRASTEVA
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:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-1405
Mailing Address - Country:US
Mailing Address - Phone:540-742-5299
Mailing Address - Fax:
Practice Address - Street 1:2220 ENCHANTED FOREST RD
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-9305
Practice Address - Country:US
Practice Address - Phone:540-742-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60885597163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice