Healthcare Provider Details

I. General information

NPI: 1104744499
Provider Name (Legal Business Name): PERLA VIOLETA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CONCOURS STE 4102
ONTARIO CA
91764-6564
US

IV. Provider business mailing address

2851 S LA CADENA DR SPC 32
COLTON CA
92324-3806
US

V. Phone/Fax

Practice location:
  • Phone: 909-240-1764
  • Fax: 909-259-2369
Mailing address:
  • Phone: 951-261-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: