Provider Demographics
NPI:1093586547
Name:RIVERA, MELANIE I
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:I
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11906 HART ST APT 6
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-5772
Mailing Address - Country:US
Mailing Address - Phone:854-218-0051
Mailing Address - Fax:
Practice Address - Street 1:269 E MARKER ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-1219
Practice Address - Country:US
Practice Address - Phone:854-218-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider