Basic Information
| Provider Information | |||||||||
| NPI: | 1790712610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA-GARCIA | ||||||||
| FirstName: | LIOVA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1446 N RANDALL AVE | ||||||||
| Address2: | |||||||||
| City: | JANESVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535451122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087587215 | ||||||||
| FaxNumber: | 6087583216 | ||||||||
| Practice Location | |||||||||
| Address1: | 1999 HIGHWAY 51 S | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380193630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014764457 | ||||||||
| FaxNumber: | 9014754389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 40650 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4134188 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 626001636 | 01 | TN | USA MANAGED CARE | OTHER | 626001636 | 01 | TN | BAPTIST HEALTH SERVICES G | OTHER | 10024068 | 01 | TN | UAHC | OTHER | 188302 | 01 | TN | UNISON | OTHER | 37949 | 01 | TN | TLC | OTHER | 626001636 | 01 | TN | UNITED HEALTHCARE | OTHER | 3337548 | 05 | TN | MEDICAID |