Provider Demographics
NPI:1376892299
Name:RIVAS, JULIO C (CS)
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:C
Last Name:RIVAS
Suffix:
Gender:M
Credentials:CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 TREASURE TRAIL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068
Mailing Address - Country:US
Mailing Address - Phone:323-512-7999
Mailing Address - Fax:
Practice Address - Street 1:6800 TREASURE TRAIL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068
Practice Address - Country:US
Practice Address - Phone:323-512-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374K00000X
CA374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner