Individual
EDWIN RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
4647 ZION AVE, SAN DIEGO, CA 92120-2507
(619) 528-2595
Mailing address
4647 ZION AVE, SAN DIEGO, CA 92120-2507
(619) 528-2595
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA14420
CA
Other
Enumeration date
11/15/2005
Last updated
11/29/2021
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