Healthcare Provider Details

I. General information

NPI: 1457584591
Provider Name (Legal Business Name): MARIA CORAZON RIVERA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7759 CALIFORNIA AVE.
RIVERSIDE CA
92504
US

IV. Provider business mailing address

7759 CALIFORNIA AVE.
RIVERSIDE CA
92504
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-2733
  • Fax: 951-688-6253
Mailing address:
  • Phone: 951-688-2733
  • Fax: 951-688-6253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: