Healthcare Provider Details

I. General information

NPI: 1609738848
Provider Name (Legal Business Name): ISRAEL RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CESAR CHAVEZ # 2610
SAN FRANCISCO CA
94110-4403
US

IV. Provider business mailing address

338 SPEAR ST UNIT 3H
SAN FRANCISCO CA
94105-6167
US

V. Phone/Fax

Practice location:
  • Phone: 765-637-3909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number95287116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: