Active NPI
Manuel Rivera, PH.D.
- Clinical Psychologist
- San Fernando, CA
National Provider Identifier
1770600678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY20060
- Practice address
- 110 N Maclay Ave
San Fernando, CA 91340-2989 - Phone
- (818) 321-3918
- Fax
- (818) 334-2448
- NPI assigned
- Mar 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY20060 | CA | Primary |
Addresses
Primary practice location
110 N Maclay Ave
San Fernando, CA 91340-2989
Mailing address
1501 Silverwood Dr
Los Angeles, CA 90041-3124
Phone (818) 606-0592
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY20060 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623024000000",
"number": "1770600678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 SILVERWOOD DR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900413124",
"telephone_number": "818-606-0592",
"fax_number": "818-334-2448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 N MACLAY AVE",
"city": "SAN FERNANDO",
"state": "CA",
"postal_code": "913402989",
"telephone_number": "818-321-3918",
"fax_number": "818-334-2448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "MANUEL",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-23",
"last_updated": "2021-06-07",
"certification_date": "2021-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY20060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Fernando, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.