Healthcare Provider Details

I. General information

NPI: 1316091309
Provider Name (Legal Business Name): JOANNE P. RIVERA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W. AMERICAN CANYON RD. SUITE M-8
AMERICAN CANYON CA
94503
US

IV. Provider business mailing address

120 W. AMERICAN CANYON RD. SUITE M-8
AMERICAN CANYON CA
94503
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-9080
  • Fax:
Mailing address:
  • Phone: 707-557-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: