Provider Demographics
NPI:1578547030
Name:RIVERA, JULIO M (MD)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:613 ELIZABETH ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2220
Mailing Address - Country:US
Mailing Address - Phone:361-888-7082
Mailing Address - Fax:361-888-7084
Practice Address - Street 1:613 ELIZABETH ST
Practice Address - Street 2:SUITE 601
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2220
Practice Address - Country:US
Practice Address - Phone:361-888-7082
Practice Address - Fax:361-888-7084
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2013-04-30
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Provider Licenses
StateLicense IDTaxonomies
TXF6093208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000KA512Medicaid
TX00KA51Medicare PIN
TXP000KA512Medicaid