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General NPI Number Information
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NPI Number | 1619684982
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Entity Type | Individual
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Provider Name | ERNESTO RIVERA
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Gender | Male
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 2119 E HATCH RD STE A
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City | MODESTO
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State | CA
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Zip | 95351-4814
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Country | US
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Telephone | 209-812-3055
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Fax |
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Provider Business Mailing Address
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Address Line | 829 CHARLES RD
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City | HUGHSON
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State | CA
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Zip | 95326-9511
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Country | US
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Telephone | 209-505-2156
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 302796
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License Number State | CA
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