Provider Demographics
NPI:1760686133
Name:RIVERA, CARMEN LIDIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:LIDIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:CARMEN
Other - Middle Name:LIDIA
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:618 CASA VERDE ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-7903
Mailing Address - Country:US
Mailing Address - Phone:661-364-0311
Mailing Address - Fax:
Practice Address - Street 1:1830 FLOWER ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4144
Practice Address - Country:US
Practice Address - Phone:661-326-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 338563 NP13879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily