Individual
LUIS RIVERABARRERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
159 TROUT AVE, GROTON, CT 06349
(912) 464-7312
Mailing address
159 TROUT AVE, GROTON, CT 06349
(912) 464-7312
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CT
Other
Enumeration date
08/08/2022
Last updated
08/08/2022
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