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NPI Code Detail

MEDICARE: MRS. MILADYS M RIVAS MS, OTR/L

MEDICARE: MRS. MILADYS M RIVAS MS, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist10199CA
2225X00000XOccupational Therapist10199CA

General Provider Information

NPI Number : 1154550887
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MILADYS M RIVAS MS, OTR/L
Provider Business Mailing Address
First Line : 625 FAIR OAKS AVE STE 200
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-2694
Country : US
Telephone Number : 323-341-5580
Fax Number : 323-340-8298
Provider Business Practice Location Address
First Line : 1111 W 6TH ST STE 111
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-1823
Country : US
Telephone Number : 323-404-1027
Fax Number : 323-340-8298
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2009
Last Update Date : 07/03/2009

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