Provider Demographics
NPI:1912573874
Name:JIVAN, SALINA M (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:SALINA
Middle Name:M
Last Name:JIVAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21248 WILDER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-2415
Mailing Address - Country:US
Mailing Address - Phone:916-764-0516
Mailing Address - Fax:
Practice Address - Street 1:17050 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518-2806
Practice Address - Country:US
Practice Address - Phone:951-697-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21696225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist