Provider Demographics
NPI:1477698116
Name:RIVERA, JUAN RAMON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:RAMON
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:RAMON
Other - Last Name:RIVERA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:655 EUCLID AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2957
Mailing Address - Country:US
Mailing Address - Phone:619-267-8313
Mailing Address - Fax:619-472-2008
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-267-8313
Practice Address - Fax:619-472-2008
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65911207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology