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NPI Code Detail

MEDICARE: KAETH RIVERA

MEDICARE: KAETH 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
1225X00000XOccupational Therapist28783CA

General Provider Information

NPI Number : 1689513541
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAETH RIVERA
Provider Business Mailing Address
First Line : 5275 MONROE AVE APT 27
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-4756
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4010 MORENA BLVD STE 103
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-4547
Country : US
Telephone Number : 619-356-1315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2026
Last Update Date : 03/26/2026

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Directions to “ KAETH RIVERA ” Practice Location

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