Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1114572443 |
---|---|
Provider Name | Anthony Stuart Rivera |
First Address | Las Vegas, NV 89107-2408 |
Second Address | Las Vegas, NV 89107-2408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2019 |
Last Update Date | 04/08/2019 |