Provider Demographics
NPI:1548439532
Name:RIVERA, JOSE ANTONIO (RRT, RCP)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 POINT LOMA CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6139
Mailing Address - Country:US
Mailing Address - Phone:619-934-1438
Mailing Address - Fax:
Practice Address - Street 1:1650 POINT LOMA CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6139
Practice Address - Country:US
Practice Address - Phone:619-934-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARCP 10706227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered