Healthcare Provider Details

I. General information

NPI: 1790301919
Provider Name (Legal Business Name): JULIO CESAR RIVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9517 MAYNE ST
BELLFLOWER CA
90706-5216
US

IV. Provider business mailing address

11635 SOUTH ST
ARTESIA CA
90701-6628
US

V. Phone/Fax

Practice location:
  • Phone: 323-395-9267
  • Fax:
Mailing address:
  • Phone: 310-820-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number60742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: