Provider Demographics
NPI:1609120658
Name:RIVERA ASTACIO, CHRISTIAN JOEL
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:JOEL
Last Name:RIVERA ASTACIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRANCH HEALTH CLINIC DIEGO GARCIA
Mailing Address - Street 2:PSC 466 BOX # 3
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96595-0003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:NAVAL MEDICAL CENTER SAN DIEGO
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5291
Practice Address - Country:US
Practice Address - Phone:619-532-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman