MEDICARE: MR. EFRAIN JOSE RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1023656535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EFRAIN JOSE RIVERA

Provider Business Mailing Address
First Line	:	160 NORTHAVEN TER
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-5518
Country	:	US
Telephone Number	:	585-622-2585
Fax Number	:	585-336-8150

Provider Business Practice Location Address
First Line	:	160 NORTHAVEN TER
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-5518
Country	:	US
Telephone Number	:	585-622-2585
Fax Number	:	585-336-8150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2019
Last Update Date	:	12/16/2019

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