Provider Demographics
NPI:1831126655
Name:RIVERA, MANUEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:C
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2983 CHINO AVE
Mailing Address - Street 2:STE A-2
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3576
Mailing Address - Country:US
Mailing Address - Phone:909-465-6342
Mailing Address - Fax:909-465-6345
Practice Address - Street 1:2983 CHINO AVE
Practice Address - Street 2:STE A-2
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3576
Practice Address - Country:US
Practice Address - Phone:909-465-6342
Practice Address - Fax:909-465-6345
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A376760OtherMEDICARE-NORTHERN CA
CA00A376760OtherMEDICARE-NORTHERN CA