Provider Demographics
NPI:1255722732
Name:RIVERA, MELBA M (MS ED, BCBA)
Entity type:Individual
Prefix:MISS
First Name:MELBA
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 E GUASTI RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8661
Mailing Address - Country:US
Mailing Address - Phone:909-240-1764
Mailing Address - Fax:909-259-2369
Practice Address - Street 1:3200 E GUASTI RD STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-8661
Practice Address - Country:US
Practice Address - Phone:909-240-1764
Practice Address - Fax:909-259-2369
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-38617103K00000X
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst