MEDICARE: MANUEL O RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	PRS.007455	OH

General Provider Information

NPI Number	:	1265387179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL O RIVERA

Provider Business Mailing Address
First Line	:	163 S WARREN AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-3064
Country	:	US
Telephone Number	:	380-241-9770
Fax Number	:	614-792-6240

Provider Business Practice Location Address
First Line	:	3121 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1306
Country	:	US
Telephone Number	:	614-869-2002
Fax Number	:	614-792-6240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “ MANUEL O RIVERA ” Practice Location

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