Healthcare Provider Details

I. General information

NPI: 1124885678
Provider Name (Legal Business Name): CYNTHIA RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 W RUMBLE RD
MODESTO CA
95350-0155
US

IV. Provider business mailing address

2630 W RUMBLE RD
MODESTO CA
95350-0155
US

V. Phone/Fax

Practice location:
  • Phone: 559-536-0853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: