Provider Demographics
NPI:1801586482
Name:LARIVIERE, INGRID
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:LARIVIERE
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 1:495 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2763
Mailing Address - Country:US
Mailing Address - Phone:831-334-2873
Mailing Address - Fax:
Practice Address - Street 1:495 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2763
Practice Address - Country:US
Practice Address - Phone:831-334-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program