Provider Demographics
NPI:1861239014
Name:ALEJOS RIVERA, ADELINA EUGENIA (PMHNP)
Entity type:Individual
Prefix:
First Name:ADELINA
Middle Name:EUGENIA
Last Name:ALEJOS RIVERA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14435 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-8208
Mailing Address - Country:US
Mailing Address - Phone:760-987-4474
Mailing Address - Fax:
Practice Address - Street 1:14435 POPLAR ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92344-8208
Practice Address - Country:US
Practice Address - Phone:760-987-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95030387364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health