Healthcare Provider Details

I. General information

NPI: 1558132431
Provider Name (Legal Business Name): JESUS ARTURO RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8919 CALIFORNIA AVE
SOUTH GATE CA
90280-3013
US

IV. Provider business mailing address

12070 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3771
US

V. Phone/Fax

Practice location:
  • Phone: 323-487-5002
  • Fax:
Mailing address:
  • Phone: 562-777-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: