| Doctor Name: | DIANE RIVERA |
| NPI Number: | 1225486194 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 623780 |
| Business Practice Address: | 101 Airport Road Santa Teresa, NM - 88008 |
| Business Phone Number: | 5755895314 |
| Business Fax Number: | |
| Mailing Address: | Po Box 70, ANTHONY |
| State: | NM |
| Postal Code: | 880210070 |
| Phone Number: | 5758826100 |
| Fax Number: | |
| NPI Enumeration Date: | 06/01/2016 |
| NPI Last Update Date: | 06/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WS0200X |
| License Number: | 623780 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |