Provider Demographics
NPI:1316552995
Name:RIVAS, DESIREE (RD, IBCLC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 E AVENUE K14
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-2947
Mailing Address - Country:US
Mailing Address - Phone:661-547-0491
Mailing Address - Fax:
Practice Address - Street 1:44216 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4134
Practice Address - Country:US
Practice Address - Phone:661-726-6462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86146091133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered