Provider Demographics
NPI:1386891232
Name:RIVERA ANTONGIORGI, NIKAURY (MD)
Entity type:Individual
Prefix:
First Name:NIKAURY
Middle Name:
Last Name:RIVERA ANTONGIORGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NIKAURY
Other - Middle Name:
Other - Last Name:RIVERA ANTONGIORGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 WILLFORD HALL LOOP BUILDING 4554
Mailing Address - Street 2:
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-9908
Mailing Address - Country:US
Mailing Address - Phone:210-292-7361
Mailing Address - Fax:
Practice Address - Street 1:1100 WILLFORD HALL LOOP, BLDG 4554
Practice Address - Street 2:ATTN: 59 MDW/SGHC
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:956-794-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP27722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry