Provider Demographics
NPI:1811719479
Name:RIVAS, KIANA
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:
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 1:103 CORNELIA CT
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-5820
Mailing Address - Country:US
Mailing Address - Phone:562-316-4211
Mailing Address - Fax:
Practice Address - Street 1:413 W MONTGOMERY CROSS RD STE 600
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3364
Practice Address - Country:US
Practice Address - Phone:912-376-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician