Provider Demographics
NPI:1366427395
Name:RIVERA, LISA KATHERINE (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:KATHERINE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:92-243 HOALII PL
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2510
Mailing Address - Country:US
Mailing Address - Phone:805-218-6823
Mailing Address - Fax:
Practice Address - Street 1:590 MOFFET ST, BLDG 4077
Practice Address - Street 2:JOINT BASE PEARL HARBOR-HICKAM
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96853-5168
Practice Address - Country:US
Practice Address - Phone:808-448-4500
Practice Address - Fax:808-448-4589
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02002823A207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology