Provider Demographics
NPI:1316784150
Name:RIVERA OLIVERA, MARIEL
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:
Last Name:RIVERA OLIVERA
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 1:800 LEISURE LAKE DR APT R7
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7384
Mailing Address - Country:US
Mailing Address - Phone:787-377-7977
Mailing Address - Fax:
Practice Address - Street 1:800 LEISURE LAKE DR APT R7
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7384
Practice Address - Country:US
Practice Address - Phone:787-377-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker