Healthcare Provider Details

I. General information

NPI: 1144684242
Provider Name (Legal Business Name): PATRICIA RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 SPRING ST
MOUNT PLEASANT WI
53405-1667
US

IV. Provider business mailing address

11254 S AVENUE N
CHICAGO IL
60617-7142
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-8460
  • Fax:
Mailing address:
  • Phone: 773-841-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number69273
License Number StateWI
# 2
Primary TaxonomyN
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: