Healthcare Provider Details

I. General information

NPI: 1669334074
Provider Name (Legal Business Name): MA IONE SKYE RIVERA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

660 E LOS ANGELES AVE STE B2
SIMI VALLEY CA
93065-1884
US

IV. Provider business mailing address

660 E LOS ANGELES AVE STE B2
SIMI VALLEY CA
93065-1884
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-1845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number755548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: