Provider Demographics
NPI:1740067438
Name:RIVERA, JENNY NATALIE
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:NATALIE
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 1:25227 CORTE SOMBRERO
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5229
Mailing Address - Country:US
Mailing Address - Phone:442-226-6080
Mailing Address - Fax:
Practice Address - Street 1:25227 CORTE SOMBRERO
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5229
Practice Address - Country:US
Practice Address - Phone:442-226-6080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker