Healthcare Provider Details

I. General information

NPI: 1356206502
Provider Name (Legal Business Name): NICOLE MARIAH RIVAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SAN RAMON VALLEY BLVD STE 102
DANVILLE CA
94526-4021
US

IV. Provider business mailing address

17 RED PINE CT
DANVILLE CA
94506-4512
US

V. Phone/Fax

Practice location:
  • Phone: 925-683-3292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: