Provider Demographics
NPI:1033815824
Name:RIVERA, ALBERTO ALEXANDER
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:ALEXANDER
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ESTUDILLO AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4906
Mailing Address - Country:US
Mailing Address - Phone:510-483-1928
Mailing Address - Fax:
Practice Address - Street 1:425 ESTUDILLO AVE STE D
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4906
Practice Address - Country:US
Practice Address - Phone:510-483-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician