Healthcare Provider Details

I. General information

NPI: 1740038769
Provider Name (Legal Business Name): ALEJANDRA RIVAS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 COLDWATER CANYON AVE
NORTH HOLLYWOOD CA
91605-5162
US

IV. Provider business mailing address

16013 GRESHAM ST
NORTH HILLS CA
91343-4837
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-8836
  • Fax:
Mailing address:
  • Phone: 818-636-4872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95035066
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95164604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: