Provider Demographics
NPI:1316475478
Name:RIVERA, JULIUS CARANDANG
Entity type:Individual
Prefix:
First Name:JULIUS
Middle Name:CARANDANG
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 1:576 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6502
Mailing Address - Country:US
Mailing Address - Phone:707-364-7185
Mailing Address - Fax:
Practice Address - Street 1:19312 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-5487
Practice Address - Country:US
Practice Address - Phone:707-935-5345
Practice Address - Fax:707-935-5423
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist