Provider Demographics
NPI:1477227007
Name:RIVERA, JONATHAN
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
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 1:2913 W ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-3010
Mailing Address - Country:US
Mailing Address - Phone:714-673-7367
Mailing Address - Fax:
Practice Address - Street 1:15161 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1432
Practice Address - Country:US
Practice Address - Phone:714-267-5129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator