Provider Demographics
NPI:1093998007
Name:RIVERA, JUANITA (LVN)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 HOTEL CIRCLE CT
Mailing Address - Street 2:STE. #130
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4420 HOTEL CIRCLE CT
Practice Address - Street 2:STE. #130
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3411
Practice Address - Country:US
Practice Address - Phone:619-543-0556
Practice Address - Fax:619-543-0562
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 227006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health