Healthcare Provider Details

I. General information

NPI: 1033033584
Provider Name (Legal Business Name): KATRINA RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7038 OWENSMOUTH AVE
CANOGA PARK CA
91303-3198
US

IV. Provider business mailing address

2768 SEPULVEDA BLVD # 1113
TORRANCE CA
90505-2952
US

V. Phone/Fax

Practice location:
  • Phone: 626-393-8308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: