Provider Demographics
NPI:1932984440
Name:NOGUEZ-RIVERA, IVAN
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:NOGUEZ-RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 AVA LOMA ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5504
Practice Address - Country:US
Practice Address - Phone:714-848-8319
Practice Address - Fax:714-596-6274
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician