Provider Demographics
NPI:1609988716
Name:RIVAS, RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 HAVEN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-6941
Mailing Address - Country:US
Mailing Address - Phone:909-851-2646
Mailing Address - Fax:
Practice Address - Street 1:6331 HAVEN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-6941
Practice Address - Country:US
Practice Address - Phone:909-851-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor