Healthcare Provider Details

I. General information

NPI: 1518409820
Provider Name (Legal Business Name): ADRIANA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N COURT ST
VISALIA CA
93291-4918
US

IV. Provider business mailing address

201 N COURT ST
VISALIA CA
93291-4918
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-2046
  • Fax:
Mailing address:
  • Phone: 559-627-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF95704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: