Healthcare Provider Details

I. General information

NPI: 1376892299
Provider Name (Legal Business Name): JULIO C RIVAS CS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 TREASURE TRAIL
LOS ANGELES CA
90068
US

IV. Provider business mailing address

6800 TREASURE TRAIL
LOS ANGELES CA
90068
US

V. Phone/Fax

Practice location:
  • Phone: 323-512-7999
  • Fax:
Mailing address:
  • Phone: 323-512-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: