Provider Demographics
NPI:1710022462
Name:RIVERA, JUDITH (FNP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 EUCLID AVE
Mailing Address - Street 2:SUITE # 409
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2957
Mailing Address - Country:US
Mailing Address - Phone:619-267-8313
Mailing Address - Fax:619-472-2008
Practice Address - Street 1:2345 E 8TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2800
Practice Address - Country:US
Practice Address - Phone:619-779-7905
Practice Address - Fax:619-779-7906
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily