Provider Demographics
NPI:1639481310
Name:RIVERA, MIREYA URRUTIA (L V N)
Entity Type:Individual
Prefix:MRS
First Name:MIREYA
Middle Name:URRUTIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:L V N
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9112 REMICK AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-4325
Mailing Address - Country:US
Mailing Address - Phone:818-504-2054
Mailing Address - Fax:818-504-2054
Practice Address - Street 1:9112 REMICK AVE
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-4325
Practice Address - Country:US
Practice Address - Phone:818-504-2054
Practice Address - Fax:818-504-2054
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA186531164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse