Healthcare Provider Details

I. General information

NPI: 1699489518
Provider Name (Legal Business Name): YVETTE MARIE RIVERA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 WESTWOOD PLAZA
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

1444 W 1ST ST
SAN PEDRO CA
90732-3206
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-4073
  • Fax:
Mailing address:
  • Phone: 323-491-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95067659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: