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General NPI Number Information
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NPI Number | 1821572249
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Entity Type | Individual
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Provider Name | JORDAN CRUZ RIVERA MD,MPH
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Gender | Male
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 1433 S ROBERTSON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-3414
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Country | US
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Telephone | 310-785-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 823 GATEWAY CENTER WAY
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City | SAN DIEGO
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State | CA
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Zip | 92102-4541
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Country | US
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Telephone | 619-515-2300
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A166171
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License Number State | CA
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