Individual
FATIMA RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1825 SAMAR DR, COSTA MESA, CA 92626-3631
(714) 429-1658
(714) 979-9982
Mailing address
1825 SAMAR DR, COSTA MESA, CA 92626-3631
(714) 429-1658
(714) 979-9982
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
306000126
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
306000126
MEDI-CAL
CA
Enumeration date
01/12/2015
Last updated
01/12/2015
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