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General NPI Number Information
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NPI Number | 1235529140
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Entity Type | Organization
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Legal Business Name | DELARIVA MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 3477 CASTLE CREEK CT
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City | ROSEVILLE
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State | CA
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Zip | 95661-7354
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Country | US
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Telephone | 916-778-6311
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 441
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City | SUISUN CITY
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State | CA
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Zip | 94585-0441
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN DE LA RIVA
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Credential |
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Telephone | 916-778-6311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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