Active NPI
Juan Rivera, MD
- Pediatrics Physician
- Vancouver, WA
National Provider Identifier
1316981244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD00024495
- Practice address
- 700 NE 87TH Ave
Vancouver, WA 98664-1913 - Phone
- (360) 397-1500
- Fax
- (360) 397-3128
- NPI assigned
- Jun 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD00024495 | WA | Primary |
Addresses
Primary practice location
700 NE 87TH Ave
Vancouver, WA 98664-1913
Mailing address
700 NE 87TH Ave
Vancouver, WA 98664-1913
Phone (360) 397-1500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1071372 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00024495 | WA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203638400000",
"number": "1316981244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 NE 87TH AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986641913",
"telephone_number": "360-397-1500",
"fax_number": "360-397-3128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 NE 87TH AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986641913",
"telephone_number": "360-397-1500",
"fax_number": "360-397-3128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "JUAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2008-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WA",
"license": "MD00024495",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1071372",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.