MEDICARE: JOSE L. RIVAS, M.D., A PROFESSIONAL CORPORATION

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	174400000X	Specialist	A33853	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104131242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE L. RIVAS, M.D., A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3100 E FLORENCE AVE
Second Line	:	SUITE 7
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5848
Country	:	US
Telephone Number	:	323-583-6361
Fax Number	:	323-583-2923

Provider Business Practice Location Address
First Line	:	3100 E FLORENCE AVE
Second Line	:	SUITE 7
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5848
Country	:	US
Telephone Number	:	323-583-6361
Fax Number	:	323-583-2923

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE L. RIVAS
Credential	:	M.D.
Telephone Number	:	323-583-6361

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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