Provider Demographics
NPI:1346011855
Name:GERVACIO RIVERA, SARAH ROCHELLE SALAZAR (APCC)
Entity Type:Individual
Prefix:
First Name:SARAH ROCHELLE
Middle Name:SALAZAR
Last Name:GERVACIO RIVERA
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:GERVACIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2111
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90610-2111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12448 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1005
Practice Address - Country:US
Practice Address - Phone:562-907-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health