Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Charles C De la Riva Jr., NP-C

Individual provider Registered Nurse · NPI 1336726447

Charles C De la Riva Jr., NP-C is a Nurse Practitioner in Phoenix, Arizona. Qualified in 2021, 5 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in Arizona.

Years since qualifying
5
Licensed in
AZ
In the registry since
2021
Specialties on file
4
What do these letters mean?
NP-C — Nurse Practitioner, Certified
A nurse practitioner certified by the AANP.

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Practice location Address checks out

202 E Earll Dr Ste 360
Phoenix, AZ 85012-2677
Phone: (480) 788-5621
Fax: (480) 779-1277
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 261707 (AZ)
Registered Nurse Taxonomy 163W00000X · Licence 192810 (AZ)
Registered Nurse Taxonomy 163W00000X · Licence 261707 (AZ)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 261707 (AZ)

Record details

NPI number1336726447
Entity typeIndividual (Type 1)
GenderMale
Credentials NP-C
Sole proprietorYes
NPI enumeratedMarch 25, 2021
Last updated in NPPESSeptember 15, 2021
Certification dateSeptember 15, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations12 on file with Medicare

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