Provider Demographics
NPI:1639875677
Name:MERCADILLO RIVAS, RINA ELIZABETH (CCHW II)
Entity Type:Individual
Prefix:
First Name:RINA
Middle Name:ELIZABETH
Last Name:MERCADILLO RIVAS
Suffix:
Gender:F
Credentials:CCHW II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 MOUNT MARIAH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-1501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1799 MOUNT MARIAH DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-1501
Practice Address - Country:US
Practice Address - Phone:702-220-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW2-5062172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker