# JUAN R RIVERA JR MD PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740015411
- **Authorized official:** JUAN R RIVERA JR. MD (CEO)
- **Authorized official phone:** (619) 241-9472

## Contact information

- **Practice address:** 765 MEDICAL CENTER CT STE 201, CHULA VISTA, CA 91911-6600
- **Practice address phone:** (619) 241-9472
- **Practice address fax:** (619) 215-0138
- **Mailing address:** 4201 30TH ST, SAN DIEGO, CA 92104-1622
- **Mailing address phone:** (619) 241-9472

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/03/2024
- **Last updated:** 09/03/2024