Provider Demographics
NPI:1477734754
Name:RIVERA, VERONICA REBECA (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:REBECA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:706 N WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1524
Mailing Address - Country:US
Mailing Address - Phone:408-905-7178
Mailing Address - Fax:408-298-0119
Practice Address - Street 1:706 N WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1524
Practice Address - Country:US
Practice Address - Phone:408-905-7178
Practice Address - Fax:408-298-0119
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93252207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABE174BMedicare PIN