Healthcare Provider Details

I. General information

NPI: 1629304159
Provider Name (Legal Business Name): CATHERINE A RIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2009
Last Update Date: 10/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 COUGAR LN SE
ALBUQUERQUE NM
87123-3527
US

IV. Provider business mailing address

PO BOX 591823
SAN FRANCISCO CA
94159-1823
US

V. Phone/Fax

Practice location:
  • Phone: 805-280-1899
  • Fax:
Mailing address:
  • Phone: 805-280-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: