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General NPI Number Information
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NPI Number | 1932653383
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Entity Type | Individual
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Provider Name | JESSE ROBERT RIVERA DNP
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Gender | Male
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Dates
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Enumeration Date | 08/14/2016
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Last Update Date | 08/10/2024
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Provider Practice Location Address
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Address Line | 1 MEDICAL PLAZA DR
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City | ROSEVILLE
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State | CA
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Zip | 95661-3037
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Country | US
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Telephone | 916-781-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 18250 NW 8TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3686
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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 |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95031173
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License Number State | CA
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