Active NPI
Jordan Cruz Rivera, MD,MPH
- Psychiatry Physician
- Los Angeles, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A166171
- Practice address
- 1433 S Robertson Blvd
Los Angeles, CA 90035-3414 - Phone
- (310) 785-2121
- NPI assigned
- Sep 21, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | A166171 | CA | Primary |
Addresses
Primary practice location
1433 S Robertson Blvd
Los Angeles, CA 90035-3414
Mailing address
823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300
Other practice location 1
1400 S Grand Ave
Los Angeles, CA 90015-3048
Phone (213) 744-0801
Other practice location 2
3705 Mission Blvd
San Diego, CA 92109-7104
Phone (619) 515-2444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3705 Mission Blvd
San Diego, CA 92109-7104
Phone (619) 515-2444
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A166171 | CA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Centers of San Diego, Inc | Current | Accepting new patients | |
| Family Health Centers of San Diego, Inc | Current | Accepting new patients | |
| Family Health Centers of San Diego, Inc. | Current | Accepting new patients |
Locations
823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323
Organizations & group practices 3
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.
-
- Federally Qualified Health Center (FQHC)
- San Diego, CA
- NPI 1447281936
-
- Federally Qualified Health Center (FQHC)
- Escondido, CA
- NPI 1356178180
-
- Federally Qualified Health Center (FQHC)
- El Cajon, CA
- NPI 1932561198
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664841600000",
"number": "1821572249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "823 GATEWAY CENTER WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921024541",
"telephone_number": "619-515-2300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1433 S ROBERTSON BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900353414",
"telephone_number": "310-785-2121"
}
],
"practiceLocations": [
{
"address_1": "1400 S Grand Ave",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900153048",
"country_code": "US",
"telephone_number": "213-744-0801",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3705 Mission Blvd",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921097104",
"country_code": "US",
"telephone_number": "619-515-2444",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RIVERA",
"first_name": "JORDAN",
"middle_name": "CRUZ",
"name_prefix": "Dr.",
"credential": "MD,MPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-21",
"last_updated": "2022-10-04",
"certification_date": "2022-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A166171",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.