Healthcare Provider Details

I. General information

NPI: 1093032252
Provider Name (Legal Business Name): EDOUARD E RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 SKY PARK CIR STE D
IRVINE CA
92614-6531
US

IV. Provider business mailing address

18102 SKY PARK CIR STE D
IRVINE CA
92614-6531
US

V. Phone/Fax

Practice location:
  • Phone: 949-723-9603
  • Fax:
Mailing address:
  • Phone: 949-723-9603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number50363
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number147090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: