Antonio Rivera, MD
Individual provider Active NPI Family Medicine Physician · Winterhaven, CA
NPI 1295785186 · NPPES record last updated Mar 21, 2025
Key facts
- NPI
- 1295785186
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4301079091 (MI)
- Practice address
- 1 Indian Hill Road
Winterhaven, CA 92283 - Phone
- (760) 572-4115
- Fax
- (760) 572-2133
- NPI assigned
- May 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100319000191 | TX | Practitioner - Family Practice | 9830224583 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10220 | PR | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301079091 | MI | Yes |
Addresses
Primary practice location
1 Indian Hill Road
Winterhaven, CA 92283
Mailing address
PO Box 42532
Tucson, AZ 85733-2532
Phone (928) 919-2815
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 733255 | Medicaid | AZ |
Other providers in Winterhaven, CA
- Rosa Maria Peralta
- Maria Perry
- Thu Nguyen Trang Pham
- Cherise Louise Riley
- Margaret Rincon
- Kelli Rogers
- Cristina Romagnoli
- Aaron D Ross
- Alana Salinas
- Bianca Salinas
All providers in Winterhaven, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.