Individual
MR. LUIS FERNANDO RIVERA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
21415 43RD AVENUE CT E, SPANAWAY, WA 98387-6841
(253) 359-4195
Mailing address
21415 43RD AVENUE CT E, SPANAWAY, WA 98387-6841
(253) 359-4195
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
P160103900
WA
Other
Enumeration date
11/25/2011
Last updated
11/25/2011
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