Provider Demographics
NPI:1265037923
Name:RIVERA, CHLOE ALYNE
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:ALYNE
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 1:23811 WASHINGTON AVE # C110-296
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2275
Mailing Address - Country:US
Mailing Address - Phone:951-290-1175
Mailing Address - Fax:
Practice Address - Street 1:31775 MIDDLEBROOK LN
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7478
Practice Address - Country:US
Practice Address - Phone:951-459-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician