Healthcare Provider Details

I. General information

NPI: 1316868904
Provider Name (Legal Business Name): ROSARIO J RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9926 PALO ALTO ST
RANCHO CUCAMONGA CA
91730-1539
US

IV. Provider business mailing address

9926 PALO ALTO ST
RANCHO CUCAMONGA CA
91730-1539
US

V. Phone/Fax

Practice location:
  • Phone: 909-229-8785
  • Fax:
Mailing address:
  • Phone: 909-229-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number500276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: