Provider Demographics
NPI:1992973473
Name:RICHARD RIVERA MDPC
Entity type:Organization
Organization Name:RICHARD RIVERA MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-564-9400
Mailing Address - Street 1:1080 CHINOOK LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1850
Mailing Address - Country:US
Mailing Address - Phone:719-564-9400
Mailing Address - Fax:719-564-0497
Practice Address - Street 1:1080 CHINOOK LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1850
Practice Address - Country:US
Practice Address - Phone:719-564-9400
Practice Address - Fax:719-564-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19885261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04835047Medicaid
COC83504Medicare PIN
COE05471Medicare UPIN