Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 000000A45653 | CA |
NPI | 1013097260 |
---|---|
Provider Name | Dr. Jorge A Rivero |
First Address | Laguna Hills, CA 92653-3107 |
Second Address | Laguna Hills, CA 92653-3107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 14/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F23175 | (02) | CA |