MEDICARE: SERINA 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		CA
2	171M00000X	Case Manager/Care Coordinator	171M00000X	CA

General Provider Information

NPI Number	:	1134813686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERINA RIVERA

Provider Business Mailing Address
First Line	:	1410 F ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-1608
Country	:	US
Telephone Number	:	559-365-6668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 F ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-1608
Country	:	US
Telephone Number	:	559-365-6668
Fax Number	:

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

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/07/2023

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Directions to “ SERINA RIVERA ” Practice Location

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