Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 25MA054350 | NJ |
NPI | 1235167123 |
---|---|
Provider Name | Loyda I Rivera |
First Address | Wall Township, NJ 07719-9165 |
Second Address | Wall Township, NJ 07719-9165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |