Healthcare Provider Details

I. General information

NPI: 1437015310
Provider Name (Legal Business Name): KIANA E RIVERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 RED OAK ST STE 101
RANCHO CUCAMONGA CA
91730-0603
US

IV. Provider business mailing address

840 TOWNE CENTER DR
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-4922
  • Fax: 909-466-1190
Mailing address:
  • Phone: 909-398-1550
  • Fax: 909-398-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: