Healthcare Provider Details

I. General information

NPI: 1255407425
Provider Name (Legal Business Name): MS. MERCEDES DELIA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

IV. Provider business mailing address

237 E DONOVAN RD APT A
SANTA MARIA CA
93454-2243
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6561
  • Fax: 805-934-6525
Mailing address:
  • Phone: 805-310-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: