Healthcare Provider Details

I. General information

NPI: 1629706411
Provider Name (Legal Business Name): CIEL CHIQUEYI QUIAHUITL RIVAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA RIVAS

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 ZELZAH AVE
NORTHRIDGE CA
91325-2003
US

IV. Provider business mailing address

8945 GOLF LINKS RD
OAKLAND CA
94605-4124
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-9311
  • Fax:
Mailing address:
  • Phone: 510-317-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: