Provider Demographics
NPI:1023656535
Name:RIVERA, EFRAIN JOSE
Entity type:Individual
Prefix:MR
First Name:EFRAIN
Middle Name:JOSE
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NORTHAVEN TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-5518
Mailing Address - Country:US
Mailing Address - Phone:585-622-2585
Mailing Address - Fax:585-336-8150
Practice Address - Street 1:160 NORTHAVEN TER
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-5518
Practice Address - Country:US
Practice Address - Phone:585-622-2585
Practice Address - Fax:585-336-8150
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator