Healthcare Provider Details

I. General information

NPI: 1255035184
Provider Name (Legal Business Name): KIMBERLY LYN RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE
VISALIA CA
93291-6237
US

IV. Provider business mailing address

1520 1ST ST APT K109
CORONADO CA
92118-1528
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-4820
  • Fax:
Mailing address:
  • Phone: 619-972-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: