Provider Demographics
NPI:1619564663
Name:RIVERA, MARIA TERESA (CPM/LM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CPM/LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 AROMITAS RD
Mailing Address - Street 2:
Mailing Address - City:AROMAS
Mailing Address - State:CA
Mailing Address - Zip Code:95004-9691
Mailing Address - Country:US
Mailing Address - Phone:213-909-6929
Mailing Address - Fax:
Practice Address - Street 1:630 AROMITAS RD
Practice Address - Street 2:
Practice Address - City:AROMAS
Practice Address - State:CA
Practice Address - Zip Code:95004-9691
Practice Address - Country:US
Practice Address - Phone:213-909-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99431176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9999999999OtherPRIVATE