Provider Demographics
NPI:1447858261
Name:WESTOVER RIVERA, LISA A (CST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:WESTOVER RIVERA
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11621 KEW GARDENS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2853
Mailing Address - Country:US
Mailing Address - Phone:561-630-3870
Mailing Address - Fax:561-630-3680
Practice Address - Street 1:11621 KEW GARDENS AVE STE 101
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2853
Practice Address - Country:US
Practice Address - Phone:561-630-3870
Practice Address - Fax:561-630-3680
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL163145246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist