Provider Demographics
NPI:1326744020
Name:RIVERA DE JESUS, FELIX MIGUEL
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:MIGUEL
Last Name:RIVERA DE JESUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7407
Mailing Address - Country:US
Mailing Address - Phone:787-552-5951
Mailing Address - Fax:
Practice Address - Street 1:701 W KIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6342
Practice Address - Country:US
Practice Address - Phone:714-415-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician