Healthcare Provider Details

I. General information

NPI: 1013097260
Provider Name (Legal Business Name): JORGE A RIVERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA SUITE 108
LAGUNA HILLS CA
92653-3107
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA SUITE 108
LAGUNA HILLS CA
92653-3107
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-7262
  • Fax: 949-588-7260
Mailing address:
  • Phone: 949-588-7262
  • Fax: 949-588-7260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number000000A45653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: