Provider Demographics
NPI:1821726399
Name:RIVERA, LORENA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 EL DORADO AVE
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2714
Mailing Address - Country:US
Mailing Address - Phone:818-793-1730
Mailing Address - Fax:
Practice Address - Street 1:6842 VAN NUYS BLVD FL 6
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4653
Practice Address - Country:US
Practice Address - Phone:818-901-4830
Practice Address - Fax:818-901-8985
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program