Healthcare Provider Details

I. General information

NPI: 1841131646
Provider Name (Legal Business Name): STEPHEN RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S OLIVE ST
LOS ANGELES CA
90015-2211
US

IV. Provider business mailing address

1439 BRESEE AVE
PASADENA CA
91104-2604
US

V. Phone/Fax

Practice location:
  • Phone: 213-549-8043
  • Fax: 213-259-0245
Mailing address:
  • Phone: 213-259-0245
  • Fax: 213-259-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: