Healthcare Provider Details

I. General information

NPI: 1225974009
Provider Name (Legal Business Name): LETICIA RIVERA LICENSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 E PALMDALE BLVD STE 12
PALMDALE CA
93550-1832
US

IV. Provider business mailing address

38709 LARKIN AVE APT 2
PALMDALE CA
93550-7234
US

V. Phone/Fax

Practice location:
  • Phone: 661-449-7223
  • Fax:
Mailing address:
  • Phone: 661-221-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number39659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: