Provider Demographics
NPI:1346477338
Name:MANUEL C RIVERA MD A PROFESSIONAL CORPORATION A CALIFORNIA CORP
Entity Type:Organization
Organization Name:MANUEL C RIVERA MD A PROFESSIONAL CORPORATION A CALIFORNIA CORP
Other - Org Name:MANUEL C RIVERA MD A PROFESSIONAL CORPORATION A CALIFORNIA CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-465-6342
Mailing Address - Street 1:2983 CHINO AVE
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3576
Mailing Address - Country:US
Mailing Address - Phone:909-465-6342
Mailing Address - Fax:909-465-6345
Practice Address - Street 1:2983 CHINO AVE
Practice Address - Street 2:SUITE A-2
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3576
Practice Address - Country:US
Practice Address - Phone:909-465-6342
Practice Address - Fax:909-465-6345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANUEL C RIVERA MD A PROFESSIONAL CORPORATION A CALIFORNIA CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85038Medicare UPIN