Healthcare Provider Details

I. General information

NPI: 1457418840
Provider Name (Legal Business Name): ROGER RIVERA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 GIRARD ST
DELANO CA
93215-3808
US

IV. Provider business mailing address

PO BOX 17179
IRVINE CA
92623-7179
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-4690
  • Fax: 661-725-4658
Mailing address:
  • Phone: 949-567-3176
  • Fax: 949-567-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: