Provider Demographics
NPI:1831383850
Name:RIVERA, CARMEN MARIA (NP, CNM)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:MARIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1804
Mailing Address - Country:US
Mailing Address - Phone:650-871-8148
Mailing Address - Fax:
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:#208
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-444-0790
Practice Address - Fax:510-869-6225
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16956363L00000X
CA1735367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner