Provider Demographics
NPI:1851861967
Name:RIVERA, MIREYA (BS)
Entity Type:Individual
Prefix:
First Name:MIREYA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4653
Mailing Address - Country:US
Mailing Address - Phone:925-286-6050
Mailing Address - Fax:
Practice Address - Street 1:1620 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4653
Practice Address - Country:US
Practice Address - Phone:925-286-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician