{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "YVETTE RIVERA DMD INC",
"LastName": null,
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"FirstLineMailingAddress": "11186 TERRA VISTA PKWY",
"SecondLineMailingAddress": "#116",
"MailingAddressCityName": "RANCHO CUCAMONGA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91730-7423",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1042 N MOUNTAIN AVE",
"SecondLinePracticeLocationAddress": "SUITE A-2",
"PracticeLocationAddressCityName": "UPLAND",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91786-3695",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-931-0222",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/02/2015",
"LastUpdateDate": "12/02/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RIVERA",
"AuthorizedOfficialFirstName": "YVETTE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "562-774-6621",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "53455",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}