Healthcare Provider Details

I. General information

NPI: 1841030442
Provider Name (Legal Business Name): MRS. STEFANIE S RIVAS-AKINSIKU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 W ROSECRANS AVE APT 215
GARDENA CA
90247-2518
US

IV. Provider business mailing address

21515 HAWTHORNE BLVD STE GL-100
TORRANCE CA
90503-6501
US

V. Phone/Fax

Practice location:
  • Phone: 310-245-5803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: