Provider Demographics
NPI:1093269029
Name:RIVERA, JOSHUA RICARDO
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RICARDO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7500
Mailing Address - Country:US
Mailing Address - Phone:888-531-8385
Mailing Address - Fax:
Practice Address - Street 1:3909 S MARYLAND PKWY
Practice Address - Street 2:SUITE 311
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7500
Practice Address - Country:US
Practice Address - Phone:888-531-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2103299756103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst