Provider Demographics
NPI:1497147987
Name:RIVAS, ALISON (LAC MSOM)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:LAC MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:GARBERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95542-3406
Mailing Address - Country:US
Mailing Address - Phone:707-923-4222
Mailing Address - Fax:
Practice Address - Street 1:432 MAPLE LN
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542-3406
Practice Address - Country:US
Practice Address - Phone:707-923-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13897171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13897OtherCA LICENSING BOARD