Provider Demographics
NPI:1013642024
Name:RIVAS, LAUREN JUSTINE (NONE)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JUSTINE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3410
Mailing Address - Country:US
Mailing Address - Phone:626-239-3060
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:126 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3410
Practice Address - Country:US
Practice Address - Phone:626-239-3060
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician