Provider Demographics
NPI:1073376224
Name:RIVERA, ROBERTO OMAR JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:OMAR
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4482 BARRANCA PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4744
Mailing Address - Country:US
Mailing Address - Phone:657-263-4696
Mailing Address - Fax:
Practice Address - Street 1:4482 BARRANCA PKWY STE 130
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4744
Practice Address - Country:US
Practice Address - Phone:657-263-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor