Provider Demographics
NPI:1902588874
Name:RIVAS, RHIANNON MICHELLE
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:MICHELLE
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 1:6970 BALLENA WAY UNIT 55
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6059
Mailing Address - Country:US
Mailing Address - Phone:951-229-7112
Mailing Address - Fax:
Practice Address - Street 1:3861 MISSION AVE STE B25
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1817
Practice Address - Country:US
Practice Address - Phone:760-536-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52626225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant