Healthcare Provider Details

I. General information

NPI: 1912447160
Provider Name (Legal Business Name): KENIA CITLALY MUNOZ RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 HAYVENHURST AVE STE 322
VAN NUYS CA
91406-3813
US

IV. Provider business mailing address

14901 NORFOLK CIR
MORENO VALLEY CA
92555-7064
US

V. Phone/Fax

Practice location:
  • Phone: 800-930-5773
  • Fax: 800-930-7957
Mailing address:
  • Phone: 909-329-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-19-9975
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: