Provider Demographics
NPI:1366218224
Name:RIVERA VAZQUEZ, LIZA (BSN RN)
Entity type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:
Last Name:RIVERA VAZQUEZ
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 26764
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-8963
Mailing Address - Country:US
Mailing Address - Phone:254-338-1472
Mailing Address - Fax:
Practice Address - Street 1:CENTRAL FLORIDA KIDNEY CENTER
Practice Address - Street 2:401 SOUTH CHICKASAW TRAIL,
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825
Practice Address - Country:US
Practice Address - Phone:407-434-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28462163WE0003X, 163WW0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty