Healthcare Provider Details

I. General information

NPI: 1780518639
Provider Name (Legal Business Name): FERNANDO RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

265 N 8TH AVE
UPLAND CA
91786-5404
US

IV. Provider business mailing address

265 N 8TH AVE
UPLAND CA
91786-5404
US

V. Phone/Fax

Practice location:
  • Phone: 323-382-7330
  • Fax:
Mailing address:
  • Phone: 323-382-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95038949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: