Healthcare Provider Details

I. General information

NPI: 1851329981
Provider Name (Legal Business Name): MARTHA E. RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7133 ESTEPA DR
TUJUNGA CA
91042-3105
US

IV. Provider business mailing address

7133 ESTEPA DR
TUJUNGA CA
91042-3105
US

V. Phone/Fax

Practice location:
  • Phone: 323-261-0259
  • Fax: 323-843-2612
Mailing address:
  • Phone: 323-261-0259
  • Fax: 323-843-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberG58728
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG58728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: