Provider Demographics
NPI:1689409278
Name:RIVAS, MAURICIO ANTONIO
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:ANTONIO
Last Name:RIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3313
Mailing Address - Country:US
Mailing Address - Phone:415-635-9819
Mailing Address - Fax:
Practice Address - Street 1:64 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3313
Practice Address - Country:US
Practice Address - Phone:415-635-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist