Individual
JONATHAN RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
30125 BARNABY LN, WESLEY CHAPEL, FL 33543-3702
(813) 997-4118
(813) 994-4118
Mailing address
30125 BARNABY LN, WESLEY CHAPEL, FL 33543-3702
(813) 997-4118
(813) 994-4118
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
260407362
FL
Other
Enumeration date
01/24/2012
Last updated
01/24/2012
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