Healthcare Provider Details

I. General information

NPI: 1831383850
Provider Name (Legal Business Name): CARMEN MARIA RIVERA NP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2007
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 30TH ST #208
OAKLAND CA
94609-3424
US

IV. Provider business mailing address

2600 CARMEL DR
SAN BRUNO CA
94066-1804
US

V. Phone/Fax

Practice location:
  • Phone: 510-444-0790
  • Fax: 510-869-6225
Mailing address:
  • Phone: 650-871-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16956
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: