Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003379405 |
---|---|
Provider Name | Armando Javier Rivera Rivera |
First Address | Culver City, CA 90230-4820 |
Second Address | Inglewood, CA 90301-4009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2019 |
Last Update Date | 11/04/2019 |