Provider Demographics
NPI:1679060875
Name:RIVERA MUNGUIA, CRISTOBAL LIBORIO
Entity type:Individual
Prefix:MR
First Name:CRISTOBAL
Middle Name:LIBORIO
Last Name:RIVERA MUNGUIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 COUNTY ROAD D EAST
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1218
Mailing Address - Country:US
Mailing Address - Phone:651-403-6034
Mailing Address - Fax:651-340-7958
Practice Address - Street 1:418 COUNTY ROAD D EAST
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-1218
Practice Address - Country:US
Practice Address - Phone:651-403-6034
Practice Address - Fax:651-340-7958
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator