Healthcare Provider Details

I. General information

NPI: 1053067363
Provider Name (Legal Business Name): RIVA HEALTH PROVIDER GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 MARKET ST STE 226
DENVER CO
80202-1559
US

IV. Provider business mailing address

728 LEXINGTON WAY
BURLINGAME CA
94010-2750
US

V. Phone/Fax

Practice location:
  • Phone: 925-695-5094
  • Fax: 310-626-0149
Mailing address:
  • Phone: 925-695-5094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENN HIRSCH
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 720-500-3889