Healthcare Provider Details

I. General information

NPI: 1386377554
Provider Name (Legal Business Name): STEPHANIE DANIELLE RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

IV. Provider business mailing address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3574
  • Fax: 916-734-7539
Mailing address:
  • Phone: 916-734-3574
  • Fax: 916-734-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number1386377554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: