Provider Demographics
NPI:1114400058
Name:RIVERO, SAMANTHA ISABEL (ATC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ISABEL
Last Name:RIVERO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 VIA VERONA
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-1534
Mailing Address - Country:US
Mailing Address - Phone:818-795-5024
Mailing Address - Fax:
Practice Address - Street 1:8005 VIA VERONA
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-1534
Practice Address - Country:US
Practice Address - Phone:818-795-5024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer