Provider Demographics
NPI:1447498985
Name:RIVERA, WILLIAM BRYAN (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRYAN
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12277 APPLE VALLEY RD #450
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308
Mailing Address - Country:US
Mailing Address - Phone:760-278-9477
Mailing Address - Fax:760-813-7004
Practice Address - Street 1:18144 US HWY 18 SUITE 130
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:760-278-9477
Practice Address - Fax:760-813-7004
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
CAA 111003208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No282N00000XHospitalsGeneral Acute Care Hospital