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General NPI Number Information
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NPI Number | 1265387179
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Entity Type | Individual
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Provider Name | MANUEL O RIVERA
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Gender | Male
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 3121 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-1306
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Country | US
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Telephone | 614-869-2002
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Fax | 614-792-6240
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Provider Business Mailing Address
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Address Line | 163 S WARREN AVE
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City | COLUMBUS
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State | OH
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Zip | 43204-3064
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Country | US
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Telephone | 380-241-9770
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Fax | 614-792-6240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | PRS.007455
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License Number State | OH
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