Healthcare Provider Details

I. General information

NPI: 1013740695
Provider Name (Legal Business Name): IRENE NINO DE RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11425 RIVERA RD
WHITTIER CA
90606-3245
US

IV. Provider business mailing address

1411 W 190TH ST STE 110
GARDENA CA
90248-4370
US

V. Phone/Fax

Practice location:
  • Phone: 562-695-0637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: