Healthcare Provider Details

I. General information

NPI: 1003721739
Provider Name (Legal Business Name): CASEY RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MISSION AVE STE 230
OCEANSIDE CA
92058-7110
US

IV. Provider business mailing address

4515 MILANO WAY
OCEANSIDE CA
92057-7641
US

V. Phone/Fax

Practice location:
  • Phone: 858-573-2600
  • Fax: 858-573-2602
Mailing address:
  • Phone: 858-573-2600
  • Fax: 858-573-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: