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General NPI Number Information
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NPI Number | 1740015411
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Entity Type | Organization
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Legal Business Name | JUAN R RIVERA JR MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 765 MEDICAL CENTER CT STE 201
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City | CHULA VISTA
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State | CA
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Zip | 91911-6600
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Country | US
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Telephone | 619-241-9472
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Fax | 619-215-0138
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Provider Business Mailing Address
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Address Line | 4201 30TH ST
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City | SAN DIEGO
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State | CA
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Zip | 92104-1622
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Country | US
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Telephone | 619-241-9472
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JUAN R RIVERA JR.
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Credential | MD
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Telephone | 619-241-9472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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