# CHARLES C DE LA RIVA JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1336726447
- **Gender:** Man
- **Credential:** NP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 192810 | AZ | — |
| 163W00000X | Registered Nurse | 261707 | AZ | — |
| 363L00000X | Nurse Practitioner | 261707 | AZ | Yes |
| 363LF0000X | Family Nurse Practitioner | 261707 | AZ | — |

## Other

- **Enumeration date:** 03/25/2021
- **Last updated:** 10/08/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 192810 | REGISTERED NURSE | AZ |
| 01 | — | 261707 | NURSE PRACTITIONER | AZ |