Provider Demographics
NPI:1467190975
Name:RIVERA, MILENA A (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MILENA
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:MILENA
Other - Middle Name:
Other - Last Name:LOZOYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NEUROMUSCULAR
Mailing Address - Street 1:1253 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-0700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1253 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-0700
Practice Address - Country:US
Practice Address - Phone:951-580-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88697225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA88697OtherNEUROMUSCULAR AND HEALTH EDUCATOR THERAPIST