MEDICARE: NICOLE MARIAH RIVAS PA-C

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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1356206502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIAH RIVAS PA-C

Provider Business Mailing Address
First Line	:	17 RED PINE CT
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94506-4512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 SAN RAMON VALLEY BLVD STE 102
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4021
Country	:	US
Telephone Number	:	925-683-3292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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