Provider Demographics
NPI:1417089533
Name:RIVAS, WENDY (MA)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 NORTH WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:323-819-1660
Mailing Address - Fax:
Practice Address - Street 1:12433 LAMBERT ROAD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606
Practice Address - Country:US
Practice Address - Phone:323-819-1660
Practice Address - Fax:323-789-3363
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52344106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA544066Medicaid