Provider Demographics
NPI:1528521739
Name:RIVERA, ANDREA RENEE (LAC, DACM)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RENEE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:RENEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, DACM
Mailing Address - Street 1:5445 DTC PKWY STE 1130
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3038
Mailing Address - Country:US
Mailing Address - Phone:720-749-5599
Mailing Address - Fax:720-925-5897
Practice Address - Street 1:640 PLAZA DR STE 270
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2508
Practice Address - Country:US
Practice Address - Phone:303-626-8501
Practice Address - Fax:720-925-5897
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-13
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18506171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist