Individual
CHARLES C DE LA RIVA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
202 E EARLL DR STE 360, PHOENIX, AZ 85012-2677
(480) 788-5621
(480) 779-1277
Mailing address
202 E EARLL DR STE 360, PHOENIX, AZ 85012-2677
(480) 788-5621
(480) 779-1277
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
192810
AZ
163W00000X
Registered Nurse
261707
AZ
363L00000X
Nurse Practitioner
Primary
261707
AZ
363LF0000X
Family Nurse Practitioner
261707
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192810
REGISTERED NURSE
AZ
01
—
261707
NURSE PRACTITIONER
AZ
Enumeration date
03/25/2021
Last updated
09/15/2021
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