Healthcare Provider Details

I. General information

NPI: 1073476859
Provider Name (Legal Business Name): REBECCA PRADO RIVERA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21068 ROYAL AVE
HAYWARD ACRES CA
94541-4753
US

IV. Provider business mailing address

21068 ROYAL AVE
HAYWARD ACRES CA
94541-4753
US

V. Phone/Fax

Practice location:
  • Phone: 510-514-6985
  • Fax: 510-514-6985
Mailing address:
  • Phone: 510-514-6985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: