Provider Demographics
NPI:1497072342
Name:RIVAS, MARY CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHRISTINE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5831
Mailing Address - Country:US
Mailing Address - Phone:909-938-4550
Mailing Address - Fax:
Practice Address - Street 1:3833 SCHAEFER AVE
Practice Address - Street 2:SUITE K
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5456
Practice Address - Country:US
Practice Address - Phone:909-590-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist