Healthcare Provider Details

I. General information

NPI: 1477895621
Provider Name (Legal Business Name): GARY FRANK RIVAS RD, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 SANTA ANITA AVE
EL MONTE CA
91733-1316
US

IV. Provider business mailing address

3144 SANTA ANITA AVE
EL MONTE CA
91733-1316
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-0333
  • Fax: 626-582-7990
Mailing address:
  • Phone: 626-444-0333
  • Fax: 626-582-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61522
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1057294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: