Healthcare Provider Details

I. General information

NPI: 1689082232
Provider Name (Legal Business Name): MARTHA E RIVERA M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E CESAR E CHAVEZ AVE SUITE # 3450
LOS ANGELES CA
90033-2424
US

IV. Provider business mailing address

1700 E CESAR E CHAVEZ AVE SUITE # 3450
LOS ANGELES CA
90033-2424
US

V. Phone/Fax

Practice location:
  • Phone: 323-261-0250
  • Fax: 323-261-0073
Mailing address:
  • Phone: 323-261-0250
  • Fax: 323-261-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG58728
License Number StateCA

VIII. Authorized Official

Name: DR. MARTHA E RIVERA
Title or Position: CEO
Credential: M.D.
Phone: 818-378-6687