Provider Demographics
NPI:1215762042
Name:RIVERA, MARCO PAOLO NAVARRO (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:MARCO PAOLO
Middle Name:NAVARRO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32799 RIDGE TOP LN
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3083
Mailing Address - Country:US
Mailing Address - Phone:661-670-7624
Mailing Address - Fax:
Practice Address - Street 1:32799 RIDGE TOP LN
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-3083
Practice Address - Country:US
Practice Address - Phone:661-670-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95388920163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency