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General NPI Number Information
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NPI Number | 1619839388
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Entity Type | Individual
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Provider Name | TRICIA JANE RIVERA DOMALANTA
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 5595 HUNTINGTON DR N
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City | LOS ANGELES
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State | CA
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Zip | 90032-1324
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Country | US
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Telephone | 323-576-2938
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Fax |
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Provider Business Mailing Address
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Address Line | 923 N IVY LN
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City | ANAHEIM
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State | CA
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Zip | 92801-3431
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Country | US
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Telephone | 714-234-5783
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 9898
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License Number State | CA
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