Healthcare Provider Details

I. General information

NPI: 1679404941
Provider Name (Legal Business Name): EMY L RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR STE 340
BEVERLY HILLS CA
90210-4884
US

IV. Provider business mailing address

415 N CRESCENT DR STE 340
BEVERLY HILLS CA
90210-4884
US

V. Phone/Fax

Practice location:
  • Phone: 310-362-1890
  • Fax: 310-388-5809
Mailing address:
  • Phone: 310-362-1890
  • Fax: 310-388-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95038787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: