Provider Demographics
NPI:1932093150
Name:RIVERA-MATOS, KIMBERLY TINA (RN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:TINA
Last Name:RIVERA-MATOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BEACH 19TH ST APT 9J
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3711
Mailing Address - Country:US
Mailing Address - Phone:917-446-1263
Mailing Address - Fax:
Practice Address - Street 1:120 BEACH 19TH ST APT 9J
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3711
Practice Address - Country:US
Practice Address - Phone:917-446-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY933352163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool