Provider Demographics
NPI:1396924353
Name:RIVAS, LORAINE Y
Entity type:Individual
Prefix:MRS
First Name:LORAINE
Middle Name:Y
Last Name:RIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 INTERNATIONAL BLVD FL 8
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1506
Mailing Address - Country:US
Mailing Address - Phone:510-903-7503
Mailing Address - Fax:
Practice Address - Street 1:512 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1236
Practice Address - Country:US
Practice Address - Phone:925-757-5303
Practice Address - Fax:925-978-1775
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator