Provider Demographics
NPI:1629310024
Name:RIVAS, NANCY (NP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 HOLIDAY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4218
Mailing Address - Country:US
Mailing Address - Phone:925-212-5047
Mailing Address - Fax:
Practice Address - Street 1:404 S 1ST ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-2947
Practice Address - Country:US
Practice Address - Phone:831-737-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2013-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily