Provider Demographics
NPI:1639374713
Name:RIVERA, RODOLFO R
Entity Type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:R
Last Name:RIVERA
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 1:7009 TAOS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-4382
Mailing Address - Country:US
Mailing Address - Phone:361-850-9128
Mailing Address - Fax:361-850-9128
Practice Address - Street 1:7009 TAOS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-4382
Practice Address - Country:US
Practice Address - Phone:361-850-9128
Practice Address - Fax:361-850-9128
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05821171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator