Healthcare Provider Details

I. General information

NPI: 1093344962
Provider Name (Legal Business Name): ESTAFANI RIVAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 E ST
CHULA VISTA CA
91910-2945
US

IV. Provider business mailing address

280 E ST
CHULA VISTA CA
91910-2945
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax:
Mailing address:
  • Phone: 619-662-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: