Provider Demographics
NPI:1164143392
Name:RIVERA-LLANES, JUDITH ALYSSABETH
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ALYSSABETH
Last Name:RIVERA-LLANES
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 1:4873 SEA CORAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-6408
Mailing Address - Country:US
Mailing Address - Phone:858-353-3816
Mailing Address - Fax:
Practice Address - Street 1:4873 SEA CORAL DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-6408
Practice Address - Country:US
Practice Address - Phone:858-353-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician