Provider Demographics
NPI:1215168984
Name:RIVERA, DAVID ANTONIO JR (BA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANTONIO
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 VALLEY MALL STE 300
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2620
Mailing Address - Country:US
Mailing Address - Phone:626-442-0710
Mailing Address - Fax:626-444-8381
Practice Address - Street 1:11001 VALLEY MALL STE 300
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2620
Practice Address - Country:US
Practice Address - Phone:626-442-0710
Practice Address - Fax:626-444-8381
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAICAN 856OtherLA COUNTY DMH