Healthcare Provider Details

I. General information

NPI: 1831005412
Provider Name (Legal Business Name): MRS. GISELE RADEGONDE RIVINUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 W HARRIS ST
EUREKA CA
95503-3927
US

IV. Provider business mailing address

930 W HARRIS ST
EUREKA CA
95503-3927
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-7500
  • Fax: 707-269-7556
Mailing address:
  • Phone: 707-269-7500
  • Fax: 707-269-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number267515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: