Provider Demographics
NPI:1366630303
Name:RIVAS, FRANK EDWARD (CP)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:EDWARD
Last Name:RIVAS
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 60000
Mailing Address - Street 2:FILE 31026
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:800-726-9180
Mailing Address - Fax:209-834-1158
Practice Address - Street 1:1180 W. OLIVE AVENUE
Practice Address - Street 2:SUITE H
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1900
Practice Address - Country:US
Practice Address - Phone:209-722-2440
Practice Address - Fax:209-723-2013
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224P00000X
CACP002624225000000X
CA224P00000X, 222Z00000X
CACPO02952224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist