MEDICARE: MS. BERNADETTE JOY RIVERA MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1861713174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BERNADETTE JOY RIVERA MA, CCC-SLP

Provider Business Mailing Address
First Line	:	822 1/2 CAPISTRANO PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-8105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7840 MISSION CENTER CT
Second Line	:	200
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-1319
Country	:	US
Telephone Number	:	619-692-0644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	07/09/2012

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Directions to “ MS. BERNADETTE JOY RIVERA MA, CCC-SLP” Practice Location

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