Provider Demographics
NPI:1851069066
Name:RIVAS-CABRALES, MARIANELLA
Entity Type:Individual
Prefix:
First Name:MARIANELLA
Middle Name:
Last Name:RIVAS-CABRALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NELLA
Other - Middle Name:
Other - Last Name:RIVAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:725 W DEMPSTER ST APT 105
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2564
Mailing Address - Country:US
Mailing Address - Phone:847-804-4226
Mailing Address - Fax:
Practice Address - Street 1:725 W DEMPSTER ST APT 105
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2564
Practice Address - Country:US
Practice Address - Phone:847-804-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer