Individual
MRS. LILLY MARLENE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(707) 988-4002
Mailing address
3551 ROGER BROOKE DR, FT SM HOUSTON, TX 78234-4504
(210) 539-9582
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86057016
—
Other
Enumeration date
10/15/2020
Last updated
09/20/2024
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