Provider Demographics
NPI:1801897681
Name:RIVAS, JOSE L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:RIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:L
Other - Last Name:RIVAS-BELFORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3100 E FLORENCE AVE
Mailing Address - Street 2:STE 7
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5848
Mailing Address - Country:US
Mailing Address - Phone:323-583-6361
Mailing Address - Fax:323-583-2923
Practice Address - Street 1:3100 E FLORENCE AVE
Practice Address - Street 2:STE 7
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5848
Practice Address - Country:US
Practice Address - Phone:323-583-6361
Practice Address - Fax:323-583-2923
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33853208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A33853Medicaid
CA00A33853Medicaid
B50238Medicare UPIN