Healthcare Provider Details

I. General information

NPI: 1811773302
Provider Name (Legal Business Name): MISS HEAVEN SINAI RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E WALNUT ST STE 260
PASADENA CA
91106-1800
US

IV. Provider business mailing address

1250 E WALNUT ST STE 260
PASADENA CA
91106-1800
US

V. Phone/Fax

Practice location:
  • Phone: 626-415-0420
  • Fax:
Mailing address:
  • Phone: 626-415-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC21140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: