Healthcare Provider Details

I. General information

NPI: 1366630303
Provider Name (Legal Business Name): FRANK EDWARD RIVAS CP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 W. OLIVE AVENUE SUITE H
MERCED CA
95348-1900
US

IV. Provider business mailing address

P.O. BOX 60000 FILE 31026
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-2440
  • Fax: 209-723-2013
Mailing address:
  • Phone: 800-726-9180
  • Fax: 209-834-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCP002624
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO02952
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO02952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: