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NPI Code Detail

MEDICARE: DR. DOMINIC JACOB RIVERA

MEDICARE: DR. DOMINIC JACOB 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1922943760
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOMINIC JACOB RIVERA
Provider Business Mailing Address
First Line : 12828 RAMONA BLVD UNIT 99
Second Line :
City : BALDWIN PARK
State : CA
Zip : 91706-3661
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1720 E CESAR E CHAVEZ AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-2414
Country : US
Telephone Number : 323-260-5789
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2026
Last Update Date : 04/20/2026

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Directions to “ DR. DOMINIC JACOB RIVERA ” Practice Location

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