Provider Demographics
NPI:1023647765
Name:LUCILA, MARIANNE RIVERA (RN)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:RIVERA
Last Name:LUCILA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19614 ALDBURY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-1103
Mailing Address - Country:US
Mailing Address - Phone:213-590-7611
Mailing Address - Fax:
Practice Address - Street 1:19614 ALDBURY ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-1103
Practice Address - Country:US
Practice Address - Phone:213-590-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA649777163WM0705X
CA95015652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical