Provider Demographics
NPI:1174217830
Name:RIVAS, ROSARIO D
Entity type:Individual
Prefix:
First Name:ROSARIO
Middle Name:D
Last Name:RIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-6290
Mailing Address - Country:US
Mailing Address - Phone:562-824-4407
Mailing Address - Fax:
Practice Address - Street 1:1836 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-6290
Practice Address - Country:US
Practice Address - Phone:562-824-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker