Provider Demographics
NPI:1407902406
Name:RIVAS, RICCARDO BLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICCARDO
Middle Name:BLAS
Last Name:RIVAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 10TH ST N
Mailing Address - Street 2:SUITE #303
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3815
Mailing Address - Country:US
Mailing Address - Phone:239-434-2150
Mailing Address - Fax:239-649-5051
Practice Address - Street 1:3435 10TH ST N
Practice Address - Street 2:SUITE #303
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3815
Practice Address - Country:US
Practice Address - Phone:239-434-2150
Practice Address - Fax:239-649-5051
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3708103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist