Provider Demographics
NPI:1659447977
Name:RIVERA, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:H
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:333 E MAGNOLIA BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1198
Mailing Address - Country:US
Mailing Address - Phone:818-848-1555
Mailing Address - Fax:818-842-9323
Practice Address - Street 1:333 E MAGNOLIA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1198
Practice Address - Country:US
Practice Address - Phone:818-848-1555
Practice Address - Fax:818-842-9323
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A67652Medicaid
W1515OtherEDI
X55988OtherGROUP UPN #
GR0089090OtherGROUP MEDICAL
H42835Medicare UPIN
W1515OtherEDI