Provider Demographics
NPI:1194912774
Name:RIVERA, MIGUEL (MS, LMFT)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 RALSTON STREET SUITE #100
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-289-3100
Mailing Address - Fax:805-987-0258
Practice Address - Street 1:5740 RALSTON STREET SUITE #100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-289-3100
Practice Address - Fax:805-987-0258
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF64991106H00000X
CALMFT13314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56CCOtherSHORT DOYLE PROVIDER