MEDICARE: CESAR DE JESUS RIVERA

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	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1912617952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESAR DE JESUS RIVERA

Provider Business Mailing Address
First Line	:	1259 W KING ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92410-1720
Country	:	US
Telephone Number	:	909-554-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1259 W KING ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92410-1720
Country	:	US
Telephone Number	:	909-554-0393
Fax Number	:

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

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	12/02/2022

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Directions to “ CESAR DE JESUS RIVERA ” Practice Location

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