Basic Information
| Provider Information | |||||||||
| NPI: | 1326668013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | CALEB | ||||||||
| MiddleName: | ZACHARY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2915 SUMMIT DR | ||||||||
| Address2: | |||||||||
| City: | FULTONDALE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350686022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078991161 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1720 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053258100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2020 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.