Basic Information
| Provider Information | |||||||||
| NPI: | 1154464915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | ANDREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 S OLIVE ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900153023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137461037 | ||||||||
| FaxNumber: | 2137469379 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 S OLIVE ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900153023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137461037 | ||||||||
| FaxNumber: | 2137469379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 1523 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 13767 | 01 | CA | RNP2001 | OTHER | MR1012210 | 01 | CA | DEA | OTHER | 1523 | 01 | CA | CNM2001 | OTHER | 530790 | 01 | CA | RN1997 | OTHER |