Provider Demographics
NPI:1225878606
Name:COLON RIVERA, NAHIR (LAC)
Entity type:Individual
Prefix:
First Name:NAHIR
Middle Name:
Last Name:COLON RIVERA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19379 LONG LAKE RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5513
Mailing Address - Country:US
Mailing Address - Phone:813-576-8064
Mailing Address - Fax:
Practice Address - Street 1:19379 LONG LAKE RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5513
Practice Address - Country:US
Practice Address - Phone:813-576-8064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4572171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist