Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT23233 | CA |
N | 225XM0800X | Mental Health | OT23233 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT23233 | CA |
NPI | 1043963168 |
---|---|
Provider Name | Victoria Rivera |
First Address | San Rafael, CA 94903-1951 |
Second Address | Novato, CA 94949-6120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2022 |
Last Update Date | 28/01/2022 |