Provider Demographics
NPI:1053609826
Name:RIVA, SANTO STEFANO (PT)
Entity type:Individual
Prefix:MR
First Name:SANTO
Middle Name:STEFANO
Last Name:RIVA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11825 MAJOR ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6356
Mailing Address - Country:US
Mailing Address - Phone:310-915-6100
Mailing Address - Fax:310-915-0100
Practice Address - Street 1:11825 MAJOR ST
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6356
Practice Address - Country:US
Practice Address - Phone:310-915-6100
Practice Address - Fax:310-915-0100
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 37934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist