Provider Demographics
NPI:1205228699
Name:RIVERA, LOVELLE
Entity Type:Individual
Prefix:
First Name:LOVELLE
Middle Name:
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 1:18010 ANNES CIR
Mailing Address - Street 2:206
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-6466
Mailing Address - Country:US
Mailing Address - Phone:818-370-9413
Mailing Address - Fax:323-474-6622
Practice Address - Street 1:4139 VERDUGO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3820
Practice Address - Country:US
Practice Address - Phone:323-258-2256
Practice Address - Fax:232-474-6622
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593704163WG0000X, 363L00000X
CA22020363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA593704OtherBOARD OF REGISTERED NURSING- NURSE PRACTITIONER