Provider Demographics
NPI:1023484557
Name:RIVERA, EDWARD MANUEL
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:MANUEL
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 E PACIFIC COAST HWY
Mailing Address - Street 2:FL 3
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2013
Mailing Address - Country:US
Mailing Address - Phone:562-346-6463
Mailing Address - Fax:
Practice Address - Street 1:1901 E 4TH ST STE 312
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3918
Practice Address - Country:US
Practice Address - Phone:714-972-3700
Practice Address - Fax:714-972-3744
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker