Healthcare Provider Details

I. General information

NPI: 1205228699
Provider Name (Legal Business Name): LOVELLE RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26910 SIERRA HWY STE D8
SANTA CLARITA CA
91321-2262
US

IV. Provider business mailing address

12318 WILLOW HILL DR
MOORPARK CA
93021-2765
US

V. Phone/Fax

Practice location:
  • Phone: 661-388-5750
  • Fax:
Mailing address:
  • Phone: 661-523-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number593704
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22020
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number593704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: