Individual
CHARLES PETER RIVERA
Active
Individual
CHARLES PETER RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
172V00000X
MEDI-CAL SHORT DOYLE
CA
Enumeration date
11/01/2017
Last updated
11/01/2017
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