Healthcare Provider Details

I. General information

NPI: 1518823996
Provider Name (Legal Business Name): AMANDA RILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANDY MANERI M.A. EDUCATION

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST STE 250
RIVERSIDE CA
92507-7429
US

IV. Provider business mailing address

16120 PICK PL
RIVERSIDE CA
92504-5648
US

V. Phone/Fax

Practice location:
  • Phone: 760-815-7772
  • Fax:
Mailing address:
  • Phone: 760-815-7772
  • 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: