Healthcare Provider Details

I. General information

NPI: 1780243527
Provider Name (Legal Business Name): GLADIS ELIZABETH RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLADIS ELIZABETH FIGUEROA

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 BLUE OAKS BLVD STE 213
ROSEVILLE CA
95678-7052
US

IV. Provider business mailing address

2442 FOOTHILL BLVD
OAKLAND CA
94601-1013
US

V. Phone/Fax

Practice location:
  • Phone: 877-412-8031
  • Fax:
Mailing address:
  • Phone: 510-837-1598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number139943
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: