MEDICARE: JUANITA RIVERA LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	VN 227006	CA

General Provider Information

NPI Number	:	1093998007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA RIVERA LVN

Provider Business Mailing Address
First Line	:	4420 HOTEL CIRCLE CT
Second Line	:	STE. #130
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 HOTEL CIRCLE CT
Second Line	:	STE. #130
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3411
Country	:	US
Telephone Number	:	619-543-0556
Fax Number	:	619-543-0562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	09/06/2023

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