Provider Demographics
NPI:1336346972
Name:RIVERA, TANIA LORENA (MD)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:LORENA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:L
Other - Last Name:RIVERA VIDAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8895 TOWNE CENTRE DR
Mailing Address - Street 2:SUITE 105 #377
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5542
Mailing Address - Country:US
Mailing Address - Phone:858-336-2810
Mailing Address - Fax:
Practice Address - Street 1:215 S HICKORY ST
Practice Address - Street 2:SUITE 114
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4359
Practice Address - Country:US
Practice Address - Phone:858-336-2810
Practice Address - Fax:949-798-7990
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265348207RR0500X
NJ25MA09188500207RR0500X
CAA126958207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology