Provider Demographics
NPI:1639280480
Name:RIVA-CAMBRIN, JAY K (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:K
Last Name:RIVA-CAMBRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 413030
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84141-3030
Mailing Address - Country:US
Mailing Address - Phone:801-662-5340
Mailing Address - Fax:801-662-5345
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-5340
Practice Address - Fax:801-662-5345
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6197043-1205207T00000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery