Healthcare Provider Details

I. General information

NPI: 1164731154
Provider Name (Legal Business Name): ROXANA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N AVALON BLVD
WILMINGTON CA
90744-5809
US

IV. Provider business mailing address

2550 W MAIN ST STE 301
ALHAMBRA CA
91801-7003
US

V. Phone/Fax

Practice location:
  • Phone: 310-816-9700
  • Fax: 310-816-9750
Mailing address:
  • Phone: 626-457-6900
  • Fax: 626-457-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: