Healthcare Provider Details

I. General information

NPI: 1023954187
Provider Name (Legal Business Name): JULISSA NEKELI RIVERA SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24871 S ELLSWORTH RD STE 100-151
QUEEN CREEK AZ
85142-1574
US

IV. Provider business mailing address

5416 E AZARA DR
SAN TAN VALLEY AZ
85140-0188
US

V. Phone/Fax

Practice location:
  • Phone: 480-999-7779
  • Fax: 480-359-4033
Mailing address:
  • Phone: 480-227-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: