Provider Demographics
NPI:1366296881
Name:BERRY-RIVERA, KIMBERLY PATRICIA (SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PATRICIA
Last Name:BERRY-RIVERA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34960 HOLLYOAK WAY
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-3315
Mailing Address - Country:US
Mailing Address - Phone:951-347-1904
Mailing Address - Fax:
Practice Address - Street 1:1235 INDIANA CT STE 107
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4540
Practice Address - Country:US
Practice Address - Phone:909-566-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist