Active NPI
Michael Gamboa Rivera, PHYSICAL THERAPIST
- Physical Therapist
- Modesto, CA
National Provider Identifier
1508142902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 41337
- Practice address
- 2117 Starlight Dr
Modesto, CA 95357-0890 - Phone
- (217) 257-5283
- NPI assigned
- Oct 29, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 41337 | CA | Primary |
Addresses
Primary practice location
2117 Starlight Dr
Modesto, CA 95357-0890
Mailing address
1100 Melody LN
Ste 124
Roseville, CA 95678-5205
Phone (217) 257-5283
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41337 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623110400000",
"number": "1508142902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 MELODY LN",
"address_2": "STE 124",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956785205",
"telephone_number": "217-257-5283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2117 STARLIGHT DR",
"city": "MODESTO",
"state": "CA",
"postal_code": "953570890",
"telephone_number": "217-257-5283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "MICHAEL",
"middle_name": "GAMBOA",
"name_prefix": "Mr.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-29",
"last_updated": "2021-06-08",
"certification_date": "2021-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "41337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.