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General NPI Number Information
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NPI Number | 1407314974
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Entity Type | Individual
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Provider Name | RAUL E RIVERA HERNANDEZ JR.
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Gender | Male
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Dates
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Enumeration Date | 03/04/2019
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 3027 W FLORIDA AVE
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City | HEMET
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State | CA
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Zip | 92545-3617
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Country | US
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Telephone | 951-330-4618
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Fax |
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Provider Business Mailing Address
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Address Line | 4785 COVE ST
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City | HEMET
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State | CA
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Zip | 92545-8956
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Country | US
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Telephone | 951-357-3904
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | RDA91784
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License Number State | CA
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