=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043985625
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSIAH JAMES RIVERA AMFT, APCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2021
-----------------------------------------------------
Last Update Date | 08/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4760 SEPULVEDA BLVD
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90230-4820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-390-6612
-----------------------------------------------------
Fax | 310-398-5690
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4760 SEPULVEDA BLVD
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90230-4820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-390-6612
-----------------------------------------------------
Fax | 310-398-5690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------