Healthcare Provider Details

I. General information

NPI: 1588480784
Provider Name (Legal Business Name): MAYRA GUADALUPE RIVERO-LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N MARINE AVE
WILMINGTON CA
90744-5528
US

IV. Provider business mailing address

171 JAYMILLS AVE
LONG BEACH CA
90805-4051
US

V. Phone/Fax

Practice location:
  • Phone: 323-572-4089
  • Fax:
Mailing address:
  • Phone: 323-572-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: