Provider Demographics
NPI:1427400514
Name:RIVERA, CARLOS AUGUSTO (LAC)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:AUGUSTO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14120 BEACH BLVD
Mailing Address - Street 2:SUITE 213B
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4454
Mailing Address - Country:US
Mailing Address - Phone:866-303-9355
Mailing Address - Fax:714-894-3083
Practice Address - Street 1:14120 BEACH BLVD
Practice Address - Street 2:SUITE 213B
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4454
Practice Address - Country:US
Practice Address - Phone:866-303-9355
Practice Address - Fax:714-894-3083
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14950171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist