Healthcare Provider Details

I. General information

NPI: 1780999110
Provider Name (Legal Business Name): RINA RICCI RIVERA SYLIANGCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RINA RICCI RIVERA RIVERA

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 W GRANT LINE RD
TRACY CA
95377-7309
US

IV. Provider business mailing address

2185 W GRANT LINE RD
TRACY CA
95377-7309
US

V. Phone/Fax

Practice location:
  • Phone: 209-839-3300
  • Fax: 209-839-6420
Mailing address:
  • Phone: 209-839-3300
  • Fax: 209-839-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA126627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: