Healthcare Provider Details

I. General information

NPI: 1063888451
Provider Name (Legal Business Name): LETICIA RIVERA MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE FL 9
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

550 S VERMONT AVE FL 9
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-738-4775
  • Fax: 213-637-5892
Mailing address:
  • Phone: 213-738-4775
  • Fax: 213-637-5892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF69424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: