Provider Demographics
NPI:1053693440
Name:RIVERA, DALIA ISABEL
Entity type:Individual
Prefix:MISS
First Name:DALIA
Middle Name:ISABEL
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 W CRAIG RD STE A
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5116
Mailing Address - Country:US
Mailing Address - Phone:702-750-0377
Mailing Address - Fax:702-538-7928
Practice Address - Street 1:3435 W CRAIG RD STE A
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5116
Practice Address - Country:US
Practice Address - Phone:702-750-0377
Practice Address - Fax:702-538-7928
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst