MEDICARE: VANESSA MICHELLE RIVERA AMFT

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	106H00000X	Marriage & Family Therapist	139826	CA

General Provider Information

NPI Number	:	1811765704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA MICHELLE RIVERA AMFT

Provider Business Mailing Address
First Line	:	5740 KENDALL CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-2452
Country	:	US
Telephone Number	:	909-224-8299
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 AVOCADO BLVD STE 270
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-8524
Country	:	US
Telephone Number	:	888-688-0248
Fax Number	:

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

Provider Enumeration Date	:	12/19/2023
Last Update Date	:	12/19/2023

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