Provider Demographics
NPI:1033005087
Name:RIVERA, RUBIE
Entity type:Individual
Prefix:
First Name:RUBIE
Middle Name:
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 1:4901 W BENTON ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68524-1232
Mailing Address - Country:US
Mailing Address - Phone:402-805-9524
Mailing Address - Fax:
Practice Address - Street 1:2110 FLETCHER AVE STE 104
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-5839
Practice Address - Country:US
Practice Address - Phone:505-221-3586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor