Healthcare Provider Details

I. General information

NPI: 1558222372
Provider Name (Legal Business Name): CHELENA LARRIVA RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ILLINOIS ST FL 2
SAN FRANCISCO CA
94143-2501
US

IV. Provider business mailing address

50 ESCONDIDO AVE
SAN FRANCISCO CA
94132-1327
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-0368
  • Fax:
Mailing address:
  • Phone: 415-476-0351
  • Fax: 415-476-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number630388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: