Healthcare Provider Details

I. General information

NPI: 1871104380
Provider Name (Legal Business Name): JUANA MARIA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUANA PEREZ

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23206 LYONS AVE
NEWHALL CA
91321-2667
US

IV. Provider business mailing address

PO BOX 660152
ARCADIA CA
91066-0152
US

V. Phone/Fax

Practice location:
  • Phone: 661-468-7405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT128672
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT165016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: