Reynaldo David Rivera, MD, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DDS106044 Issued in CA

Practice address

67 S Glenn Dr
Camarillo, CA 93010-7944

Phone

(805) 738-3287

NPI assigned

Apr 19, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Channel Islands Oms Group

  dba Channel Island Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Santa Barbara, CA
  • NPI 1003764572
  NPD (past)
• Channel Islands Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Camarillo, CA
  • NPI 1598419723
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1790902989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 S GLENN DR",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930107944",
            "telephone_number": "805-738-3287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 S GLENN DR",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930107944",
            "telephone_number": "805-738-3287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "REYNALDO",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD, DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019099",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901019099",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "DDS106044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianne Rivera
• Crystal Rivera, RBT
• Danielle Katie Rivera, BCBA
• Dea Rae Rivera, M.F.T.
• Miguel Rivera Jr.
• Valerie Marie Inez Rivera
• Priscilla Angelina Rivero
• Tamer Adel Riyad
• Estefania Rizo, LVN
• Tatiana Rizzotti

• Oral and Maxillofacial Surgery (Dentist) in Camarillo, CA
• Providers in Camarillo, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.