Basic Information
| Provider Information | |||||||||
| NPI: | 1245797240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | SAQUITA | ||||||||
| MiddleName: | S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142021102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168812405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142021102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168812405 | ||||||||
| FaxNumber: | 7168812425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2019 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 333001-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.