Healthcare Provider Details

I. General information

NPI: 1619563087
Provider Name (Legal Business Name): GABRIELA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31946 MISSION TRL STE B
LAKE ELSINORE CA
92530-4539
US

IV. Provider business mailing address

31946 MISSION TRL STE B
LAKE ELSINORE CA
92530-4539
US

V. Phone/Fax

Practice location:
  • Phone: 951-471-4300
  • Fax: 951-674-6431
Mailing address:
  • Phone: 951-471-4300
  • Fax: 951-674-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: