Provider Demographics
NPI:1972622595
Name:LORES RIVERON, JULIO C (LSA, CSA SAC)
Entity type:Individual
Prefix:MR
First Name:JULIO
Middle Name:C
Last Name:LORES RIVERON
Suffix:
Gender:M
Credentials:LSA, CSA SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-6820
Mailing Address - Country:US
Mailing Address - Phone:281-935-2012
Mailing Address - Fax:
Practice Address - Street 1:1823 CREEK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-6820
Practice Address - Country:US
Practice Address - Phone:281-935-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00324246ZS0410X, 246ZC0007X
TX2945246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist