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NPI Code Detail

MEDICARE: JOSE RIVERA

MEDICARE: JOSE 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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.196043OH
2171M00000XCase Manager/Care Coordinator
3175T00000XPeer Specialist

General Provider Information

NPI Number : 1598412967
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE RIVERA
Provider Business Mailing Address
First Line : 3909 WOODLEY RD
Second Line :
City : TOLEDO
State : OH
Zip : 43606-1169
Country : US
Telephone Number : 419-475-4449
Fax Number :
Provider Business Practice Location Address
First Line : 3909 WOODLEY RD
Second Line :
City : TOLEDO
State : OH
Zip : 43606-1169
Country : US
Telephone Number : 419-725-3330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2022
Last Update Date : 06/04/2026

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Directions to “ JOSE RIVERA ” Practice Location

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