Provider Demographics
NPI:1285469718
Name:RIVERA, ALEXIS ROSE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ROSE
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 1:1 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-5293
Mailing Address - Country:US
Mailing Address - Phone:508-828-9116
Mailing Address - Fax:508-828-9146
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-5293
Practice Address - Country:US
Practice Address - Phone:508-828-9116
Practice Address - Fax:508-828-9146
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program