Provider Demographics
NPI:1447022017
Name:RIVERA, FRANCISCO AZAEL (OTA)
Entity type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:AZAEL
Last Name:RIVERA
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 HAMNER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3637
Mailing Address - Country:US
Mailing Address - Phone:626-536-4834
Mailing Address - Fax:626-507-6319
Practice Address - Street 1:2641 HAMNER AVE STE 110
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3637
Practice Address - Country:US
Practice Address - Phone:626-536-4834
Practice Address - Fax:626-507-6319
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6562224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant