Provider Demographics
NPI:1881106730
Name:RIVERA, CHARLES PETER
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PETER
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:SF DEPT. OF PUBLIC HEALTH BEHAVIORAL HEALTH SERVICES
Mailing Address - Street 2:1380 HOWARD STREET, 5TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103
Mailing Address - Country:US
Mailing Address - Phone:415-255-3421
Mailing Address - Fax:
Practice Address - Street 1:1380 HOWARD ST FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2652
Practice Address - Country:US
Practice Address - Phone:415-255-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA172V00000XOtherMEDI-CAL SHORT DOYLE