Individual
JUAN LUIS LA RIVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SA
Contact information
Practice address
19015 S JODI RD STE H, MOKENA, IL 60448-8534
(866) 787-4452
Mailing address
19015 S JODI RD STE H, MOKENA, IL 60448-8534
(866) 787-4452
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
238.000786
ILLINOIS STATE LICENSE
IL
Enumeration date
06/23/2023
Last updated
06/23/2023
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