Provider Demographics
NPI:1003218660
Name:RIVAS, PATRICIA GUADALUPE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GUADALUPE
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 1:5527 ROMAINE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3273
Mailing Address - Country:US
Mailing Address - Phone:323-203-4804
Mailing Address - Fax:310-399-9678
Practice Address - Street 1:717 LINCOLN BLVD.
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291
Practice Address - Country:US
Practice Address - Phone:310-399-9883
Practice Address - Fax:310-399-9678
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)