Healthcare Provider Details

I. General information

NPI: 1063324598
Provider Name (Legal Business Name): KATYA LORENA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 E PALMDALE BLVD
PALMDALE CA
93550-4914
US

IV. Provider business mailing address

44311 STANRIDGE AVE
LANCASTER CA
93535-3622
US

V. Phone/Fax

Practice location:
  • Phone: 661-469-6460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: