Provider Demographics
NPI:1548765274
Name:SIGALOS-RIVERA, MARA ALEJANDRA (MD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:ALEJANDRA
Last Name:SIGALOS-RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:ALEJANDRA
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 N. STATE STREET
Mailing Address - Street 2:CT-A7D
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-409-5752
Mailing Address - Fax:323-409-4418
Practice Address - Street 1:1200 N. STATE STREET
Practice Address - Street 2:CT-A7D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-409-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1635142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program