MEDICARE: ANTONIO 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	363AM0700X	Medical Physician Assistant	13146	CA

General Provider Information

NPI Number	:	1679798342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO RIVERA

Provider Business Mailing Address
First Line	:	2151 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3121
Country	:	US
Telephone Number	:	213-483-2222
Fax Number	:	213-483-6161

Provider Business Practice Location Address
First Line	:	2151 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3121
Country	:	US
Telephone Number	:	213-483-2222
Fax Number	:	213-483-6161

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	10/28/2010

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Directions to “ ANTONIO RIVERA ” Practice Location

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