Healthcare Provider Details

I. General information

NPI: 1194912774
Provider Name (Legal Business Name): MIGUEL RIVERA MS., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 RALSTON STREET SUITE #100
VENTURA CA
93003
US

IV. Provider business mailing address

5740 RALSTON STREET SUITE #100
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-3100
  • Fax: 805-987-0258
Mailing address:
  • Phone: 805-289-3100
  • Fax: 805-987-0258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF64991
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT13314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: