Provider Demographics
NPI:1205228699
Name:RIVERA, LOVELLE
Entity type:Individual
Prefix:
First Name:LOVELLE
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 1:12318 WILLOW HILL DR
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2765
Mailing Address - Country:US
Mailing Address - Phone:661-523-9414
Mailing Address - Fax:
Practice Address - Street 1:26910 SIERRA HWY STE D8
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2262
Practice Address - Country:US
Practice Address - Phone:661-388-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593704163WG0000X, 363L00000X
CA22020363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA593704OtherBOARD OF REGISTERED NURSING- NURSE PRACTITIONER