Active NPI
Luis Fernando Rivera Jr., PTA
- Contractor
- Spanaway, WA
National Provider Identifier
1740557313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- P160103900
- Practice address
- 21415 43Rd Avenue CT E
Spanaway, WA 98387-6841 - Phone
- (253) 359-4195
- NPI assigned
- Nov 25, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | P160103900 | WA | Primary |
Addresses
Primary practice location
21415 43Rd Avenue CT E
Spanaway, WA 98387-6841
Mailing address
21415 43Rd Avenue CT E
Spanaway, WA 98387-6841
Phone (253) 359-4195
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P160103900 | WA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322179200000",
"number": "1740557313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21415 43RD AVENUE CT E",
"city": "SPANAWAY",
"state": "WA",
"postal_code": "983876841",
"telephone_number": "253-359-4195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21415 43RD AVENUE CT E",
"city": "SPANAWAY",
"state": "WA",
"postal_code": "983876841",
"telephone_number": "253-359-4195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "LUIS",
"middle_name": "FERNANDO",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-25",
"last_updated": "2011-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "WA",
"license": "P160103900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spanaway, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.