Healthcare Provider Details

I. General information

NPI: 1679908966
Provider Name (Legal Business Name): ESTELA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8041 NEWMAN AVE
HUNTINGTON BEACH CA
92647-7034
US

IV. Provider business mailing address

11209 SAMPSON AVE
LYNWOOD CA
90262-2832
US

V. Phone/Fax

Practice location:
  • Phone: 714-500-0224
  • Fax: 714-842-9843
Mailing address:
  • Phone: 310-749-9312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: