Provider Demographics
NPI:1215516208
Name:RIVERA, AZALIA PALOMA
Entity type:Individual
Prefix:
First Name:AZALIA
Middle Name:PALOMA
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 1:612 W LAKE LANDING RD
Mailing Address - Street 2:UNIT 400
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:855-295-3276
Mailing Address - Fax:
Practice Address - Street 1:612 W LAKE LANSING RD STE 400
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8528
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician