Healthcare Provider Details

I. General information

NPI: 1194161703
Provider Name (Legal Business Name): JORGE A. RIVERO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
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:
Mailing address:
  • Phone: 949-588-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA45653
License Number StateCA

VIII. Authorized Official

Name: JORGE RIVERO
Title or Position: OWNER
Credential: M.D.
Phone: 949-588-7262