Healthcare Provider Details

I. General information

NPI: 1104797067
Provider Name (Legal Business Name): MISS CORINA RIANNE OLIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19318 JESSE LN STE 100
RIVERSIDE CA
92508-5071
US

IV. Provider business mailing address

19318 JESSE LN STE 100
RIVERSIDE CA
92508-5071
US

V. Phone/Fax

Practice location:
  • Phone: 951-900-7411
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: