Provider Demographics
NPI:1205879079
Name:A RIVERA MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:A RIVERA MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-532-1222
Mailing Address - Street 1:6319 CASTLE PL
Mailing Address - Street 2:STE 1 E
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1907
Mailing Address - Country:US
Mailing Address - Phone:703-532-1222
Mailing Address - Fax:
Practice Address - Street 1:6319 CASTLE PL
Practice Address - Street 2:STE 1 E
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1907
Practice Address - Country:US
Practice Address - Phone:703-532-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCCS9911050OtherCDS
DCCS9911050OtherCDS
VAG01527Medicare ID - Type Unspecified
G99111Medicare UPIN