Healthcare Provider Details

I. General information

NPI: 1457298820
Provider Name (Legal Business Name): SPENCER THOMAS RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46100 OCOTILLO DR APT 3
PALM DESERT CA
92260-4673
US

IV. Provider business mailing address

46100 OCOTILLO DR APT 3
PALM DESERT CA
92260-4673
US

V. Phone/Fax

Practice location:
  • Phone: 760-851-6885
  • Fax:
Mailing address:
  • Phone:
  • 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: