Provider Demographics
NPI:1932931565
Name:RIVERO, MARINA IRENE (DO)
Entity type:Individual
Prefix:MS
First Name:MARINA
Middle Name:IRENE
Last Name:RIVERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:MARINA
Other - Middle Name:IRENE
Other - Last Name:RIVERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:9714 WALFORD MILL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5533
Mailing Address - Country:US
Mailing Address - Phone:281-808-4724
Mailing Address - Fax:
Practice Address - Street 1:9714 WALFORD MILL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5533
Practice Address - Country:US
Practice Address - Phone:281-808-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24-267246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant