Provider Demographics
NPI:1518545177
Name:RIVAS, JOEL BENEDICT
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:BENEDICT
Last Name:RIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 PLUMTREE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1638
Mailing Address - Country:US
Mailing Address - Phone:413-519-8039
Mailing Address - Fax:
Practice Address - Street 1:686 PLUMTREE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1638
Practice Address - Country:US
Practice Address - Phone:413-519-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health