Individual
MISS IBIS MABLE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1680 ALBANY AVE, HARTFORD, CT 06105-1001
(860) 236-4511
Mailing address
1680 ALBANY AVE, HARTFORD, CT 06105-1001
(860) 236-4511
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/05/2013
Last updated
07/10/2013
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