Healthcare Provider Details

I. General information

NPI: 1790696367
Provider Name (Legal Business Name): LESSLIE CONCHITA RIVERA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10551 BELLEGRAVE AVE ROOM E4
JURUPA VALLEY CA
91752
US

IV. Provider business mailing address

28930 BAY AVE
MORENO VALLEY CA
92555-8206
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-2600
  • Fax:
Mailing address:
  • Phone: 213-716-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: