Provider Demographics
NPI:1669610010
Name:RIVERA, ANA J
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:J
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 1:1647 E HOLT BLVD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2107
Mailing Address - Country:US
Mailing Address - Phone:909-458-9628
Mailing Address - Fax:909-458-9750
Practice Address - Street 1:1647 E HOLT BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2107
Practice Address - Country:US
Practice Address - Phone:909-458-9628
Practice Address - Fax:909-458-9750
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health