Provider Demographics
NPI:1316371834
Name:RIVAS, CECILIA ALEJANDRA (OD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:ALEJANDRA
Last Name:RIVAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 WINDMILL RD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7140
Mailing Address - Country:US
Mailing Address - Phone:562-201-7740
Mailing Address - Fax:
Practice Address - Street 1:11729 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2819
Practice Address - Country:US
Practice Address - Phone:562-860-4094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14751152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist