Provider Demographics
NPI:1265228217
Name:RIVERA, RHAVEENA (SLP)
Entity type:Individual
Prefix:
First Name:RHAVEENA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 AURORA ASTORGA DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-8201
Mailing Address - Country:US
Mailing Address - Phone:408-680-9055
Mailing Address - Fax:
Practice Address - Street 1:2590 AURORA ASTORGA DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-8201
Practice Address - Country:US
Practice Address - Phone:408-680-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty