Provider Demographics
NPI:1932165206
Name:RIVERA, MARTHA MONICA (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MONICA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6331
Mailing Address - Country:US
Mailing Address - Phone:559-737-4700
Mailing Address - Fax:559-734-1247
Practice Address - Street 1:401 E SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5032
Practice Address - Country:US
Practice Address - Phone:877-960-3426
Practice Address - Fax:559-737-4931
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425388207V00000X
CAA88457207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101148571Medicaid
PA087648Medicare ID - Type Unspecified
I24393Medicare UPIN