Provider Demographics
NPI:1992446769
Name:RIVERA, ROMENETTE AMOR (DO)
Entity type:Individual
Prefix:
First Name:ROMENETTE
Middle Name:AMOR
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8054
Mailing Address - Country:US
Mailing Address - Phone:870-926-8935
Mailing Address - Fax:
Practice Address - Street 1:11885 E 12 MILE RD STE 202A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3469
Practice Address - Country:US
Practice Address - Phone:586-582-7090
Practice Address - Fax:586-582-7091
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program