Provider Demographics
NPI:1104864818
Name:RIVAS, PATRICIA (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18933 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95327-9155
Mailing Address - Country:US
Mailing Address - Phone:916-549-7449
Mailing Address - Fax:
Practice Address - Street 1:13975 MONO WAY STE I
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2824
Practice Address - Country:US
Practice Address - Phone:209-533-9603
Practice Address - Fax:209-533-9604
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist