Provider Demographics
NPI:1225112527
Name:RIVERA, YONEL F (DC)
Entity Type:Individual
Prefix:DR
First Name:YONEL
Middle Name:F
Last Name:RIVERA
Suffix:
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 1:4714 REGATTA LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8505
Mailing Address - Country:US
Mailing Address - Phone:619-661-6981
Mailing Address - Fax:619-422-2727
Practice Address - Street 1:1660 BROADWAY STE 8
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4895
Practice Address - Country:US
Practice Address - Phone:619-422-2222
Practice Address - Fax:619-422-2727
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27699Medicare ID - Type Unspecified