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General NPI Number Information
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NPI Number | 1275912958
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Entity Type | Organization
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Legal Business Name | RIVERA MHT LLC
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 1515 HERITAGE DR
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City | MCKINNEY
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State | TX
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Zip | 75069-3256
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Country | US
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Telephone | 972-616-4932
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Fax | 877-489-3949
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Provider Business Mailing Address
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Address Line | 1515 HERITAGE DR
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City | MCKINNEY
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State | TX
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Zip | 75069-3256
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Country | US
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Telephone | 972-616-4932
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Fax | 877-489-3949
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DIEGO RIVERA
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Credential | MD
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Telephone | 806-723-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G1757
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License Number State | TX
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