Basic Information
| Provider Information | |||||||||
| NPI: | 1194865485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERO | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1333 BUSH STREET | ||||||||
| Address2: | ON LOK SENIOR SERVICES | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254511454 | ||||||||
| FaxNumber: | 4152928845 | ||||||||
| Practice Location | |||||||||
| Address1: | 1333 BUSH ST | ||||||||
| Address2: | ON LOK SENIOR SERVICES | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941095611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254511454 | ||||||||
| FaxNumber: | 4152928845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 02/22/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G61715 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | G61715 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G617150 | 05 | CA | MEDICAID |