Healthcare Provider Details

I. General information

NPI: 1003735457
Provider Name (Legal Business Name): TINA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 BLUE OAKS BLVD STE 260
ROSEVILLE CA
95747-4003
US

IV. Provider business mailing address

1430 BLUE OAKS BLVD STE 260
ROSEVILLE CA
95747-4003
US

V. Phone/Fax

Practice location:
  • Phone: 916-918-1828
  • Fax:
Mailing address:
  • Phone: 916-918-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: