Most Relevant Information
Provider Data
| NPI Number: | 1003544727 |
| Provider Name: | KELLIE RIVERA |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/10/2022 |
| Last Updated: | 08/10/2022 |
Provider Practice Location
473 S CARNEGIE DR STE 200
SAN BERNARDINO
CA
924084201
Practice Location Phone/Fax
| Phone: | 9514053015 |
| Fax: |
Provider Mailing Location
423 W WINCHESTER DR
RIALTO
CA
923763304
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |