Healthcare Provider Details

I. General information

NPI: 1467093641
Provider Name (Legal Business Name): MARAINA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 04/08/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 11TH ST
MODESTO CA
95354-2348
US

IV. Provider business mailing address

1301 E ORANGEWOOD AVE
ANAHEIM CA
92805-6807
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-6201
  • Fax:
Mailing address:
  • Phone: 800-249-1266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT154268
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC19099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: