Healthcare Provider Details

I. General information

NPI: 1811765704
Provider Name (Legal Business Name): VANESSA MICHELLE RIVERA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 ALTA RD STE 6100
SAN DIEGO CA
92158-0001
US

IV. Provider business mailing address

5740 KENDALL CT
RANCHO CUCAMONGA CA
91739-2452
US

V. Phone/Fax

Practice location:
  • Phone: 619-671-4400
  • Fax:
Mailing address:
  • Phone: 909-224-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number139826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: