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General NPI Number Information
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NPI Number | 1700277951
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Entity Type | Organization
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Legal Business Name | MARCELO R. RIVERA, MD, INC.
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 15644 POMERADO RD STE 300
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City | POWAY
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State | CA
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Zip | 92064-2418
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Country | US
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Telephone | 858-613-8743
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Fax |
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Provider Business Mailing Address
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Address Line | 15644 POMERADO RD STE 300
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City | POWAY
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State | CA
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Zip | 92064-2418
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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 | OFFICE MANAGER
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Name | MRS. DEBBIE MEYER
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Credential |
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Telephone | 858-613-8743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G39240
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License Number State | CA
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