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General NPI Number Information
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NPI Number | 1205628849
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Entity Type | Individual
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Provider Name | BRANDON FELIX DE LA RIVA
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Gender | Male
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 11799 SEBASTIAN WAY STE 103
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0708
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Country | US
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Telephone | 760-835-7808
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Fax |
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Provider Business Mailing Address
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Address Line | 34448 YUCAIPA BLVD STE A
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City | YUCAIPA
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State | CA
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Zip | 92399-2412
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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