Healthcare Provider Details

I. General information

NPI: 1013336452
Provider Name (Legal Business Name): KATHERINE RIVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

13001 E 17TH PL STE F546
AURORA CO
80045-2578
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-6019
  • Fax:
Mailing address:
  • Phone: 413-992-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberDR.0059949
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: