Provider Demographics
NPI:1699812230
Name:RIVERA, JESSE JAY (RN, BSN, MS, CRNA)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:JAY
Last Name:RIVERA
Suffix:
Gender:M
Credentials:RN, BSN, MS, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8861 VILLA LA JOLLA DR # 12237
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1918
Mailing Address - Country:US
Mailing Address - Phone:760-297-1284
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE STE 880
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1233
Practice Address - Country:US
Practice Address - Phone:858-404-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3576367500000X
CA533724390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program