Provider Demographics
NPI:1033844162
Name:DEL VALLE RIVAS, CINDY VALENTINA (LAC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:VALENTINA
Last Name:DEL VALLE RIVAS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 LIBERTY AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-2333
Mailing Address - Country:US
Mailing Address - Phone:201-844-7324
Mailing Address - Fax:
Practice Address - Street 1:105 GROVE ST STE 17
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4053
Practice Address - Country:US
Practice Address - Phone:917-587-0407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00161900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist