Healthcare Provider Details

I. General information

NPI: 1932779089
Provider Name (Legal Business Name): JENNIFER RIVERA M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E RINCON ST STE 219
CORONA CA
92879-1387
US

IV. Provider business mailing address

255 E RINCON ST STE 219
CORONA CA
92879-1387
US

V. Phone/Fax

Practice location:
  • Phone: 866-727-8274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-70344
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: