1780968040 NPI number — JANNY MARCELA RIVERA MA

Table of content: JANNY MARCELA RIVERA MA (NPI 1780968040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780968040 NPI number — JANNY MARCELA RIVERA MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
JANNY
Provider Middle Name:
MARCELA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780968040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15920 INDIANA AVE APT 25
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAMOUNT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90723-5124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-249-0777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6736 LAUREL CANYON BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91606-1576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-755-8786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFTI 80638 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106H00000X . This is a "MENTAL HEALTH BILLING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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