Individual
JONATHAN RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N5
Contact information
Practice address
2605 SAINT MIHIEL ST, FORT IRWIN, CA 92310-1654
(615) 663-2003
Mailing address
2605 SAINT MIHIEL ST, FORT IRWIN, CA 92310-1654
Taxonomy
Speciality
Code
Description
License number
State
126900000X
Dental Laboratory Technician
Primary
—
—
Other
Enumeration date
10/26/2017
Last updated
12/13/2018
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