Healthcare Provider Details

I. General information

NPI: 1619564663
Provider Name (Legal Business Name): MARIA TERESA RIVERA CPM/LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 AROMITAS RD
AROMAS CA
95004-9691
US

IV. Provider business mailing address

630 AROMITAS RD
AROMAS CA
95004-9691
US

V. Phone/Fax

Practice location:
  • Phone: 213-909-6929
  • Fax:
Mailing address:
  • Phone: 213-909-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99431
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: