Healthcare Provider Details

I. General information

NPI: 1730372004
Provider Name (Legal Business Name): SANDRA RIVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA MINNERLY

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 N H ST
LOMPOC CA
93436-4519
US

IV. Provider business mailing address

610 SHADY LN
SANTA MARIA CA
93455-3819
US

V. Phone/Fax

Practice location:
  • Phone: 805-865-1940
  • Fax: 805-865-1947
Mailing address:
  • Phone: 805-588-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1295817302
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerTELECARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: