Healthcare Provider Details

I. General information

NPI: 1649184912
Provider Name (Legal Business Name): VICTORIA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD NEWPORT BLVD STE 101
NEWPORT BEACH CA
92663-4234
US

IV. Provider business mailing address

311 JUNIPERO AVE APT 8
LONG BEACH CA
90814-5524
US

V. Phone/Fax

Practice location:
  • Phone: 949-656-4520
  • Fax:
Mailing address:
  • Phone: 505-410-8783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: