Individual
GERSON O RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8280 WILLOW OAKS CORPORATE DR STE 600, FAIRFAX, VA 22031-4516
(888) 922-2843
(855) 568-2494
Mailing address
8280 WILLOW OAKS CORPORATE DR STE 600, FAIRFAX, VA 22031-4516
(888) 922-2843
(855) 568-2494
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
374700000X
Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000678439
—
VA
Enumeration date
09/29/2022
Last updated
09/30/2022
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