Healthcare Provider Details

I. General information

NPI: 1538931365
Provider Name (Legal Business Name): KARLA YESSENIA RIVERA MORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 MYERS ST BLDG 3
RIVERSIDE CA
92503-5527
US

IV. Provider business mailing address

3125 MYERS ST BLDG 3
RIVERSIDE CA
92503-5527
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-5862
  • Fax:
Mailing address:
  • Phone: 951-358-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSSSYZCTG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: