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General NPI Number Information
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NPI Number | 1992973473
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Entity Type | Organization
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Legal Business Name | RICHARD RIVERA MDPC
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 1080 CHINOOK LN
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City | PUEBLO
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State | CO
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Zip | 81001-1850
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Country | US
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Telephone | 719-564-9400
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Fax | 719-564-0497
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Provider Business Mailing Address
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Address Line | 1080 CHINOOK LN
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City | PUEBLO
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State | CO
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Zip | 81001-1850
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Country | US
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Telephone | 719-564-9400
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Fax | 719-564-0497
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD RIVERA
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Credential | M.D.
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Telephone | 719-564-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 19885
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License Number State | CO
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