1730320797 NPI number — DR. MICHELLE RIVERA M.D.

Table of content: DR. MICHELLE RIVERA M.D. (NPI 1730320797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730320797 NPI number — DR. MICHELLE RIVERA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA-DAVILA
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1730320797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PEDIATRIC ENDOCRINOLOGY
Provider Second Line Business Mailing Address:
6431 FANNIN, MSB 3.122
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-500-5646
Provider Business Mailing Address Fax Number:
713-500-0526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PEDIATRIC ENDOCRINOLOGY
Provider Second Line Business Practice Location Address:
6410 FANNIN, SUITE 500
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-325-7693
Provider Business Practice Location Address Fax Number:
713-512-2225
Provider Enumeration Date:
03/20/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  N1860 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0205X , with the licence number: N1860 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 203413401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".