Provider Demographics
NPI:1649886789
Name:RIVERA, LATOSHA TRENET (CMT)
Entity type:Individual
Prefix:
First Name:LATOSHA
Middle Name:TRENET
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 WILDWIND CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3064
Mailing Address - Country:US
Mailing Address - Phone:916-370-5964
Mailing Address - Fax:916-917-5540
Practice Address - Street 1:3471 WILDWIND CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3064
Practice Address - Country:US
Practice Address - Phone:916-370-5964
Practice Address - Fax:916-917-5540
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72206225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist