Provider Demographics
NPI:1427376565
Name:RIVERA, IRENE NORMA (RN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:NORMA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 HUGHES AVE STE 604
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6848
Mailing Address - Country:US
Mailing Address - Phone:310-839-4381
Mailing Address - Fax:
Practice Address - Street 1:3831 HUGHES AVE STE 604
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6848
Practice Address - Country:US
Practice Address - Phone:310-839-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN388734163W00000X
CA925367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN388734OtherBOARD OF REGISTERED NURSING
CA925OtherMIDWIFE LICENSE NUMBER