Provider Demographics
NPI:1679537104
Name:RIVERA, WANDA ACUNA (RD CD)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:ACUNA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 N 2475 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8237
Mailing Address - Country:US
Mailing Address - Phone:801-586-6022
Mailing Address - Fax:801-777-5760
Practice Address - Street 1:6036 CEDAR LN
Practice Address - Street 2:BLDG 1277
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5812
Practice Address - Country:US
Practice Address - Phone:801-586-6022
Practice Address - Fax:801-777-5760
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered