Healthcare Provider Details

I. General information

NPI: 1083113484
Provider Name (Legal Business Name): MANDY RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY RENE RIVAS-CROSS

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ESTUDILLO AVE. STE. 100
SAN LEANDRO CA
94577
US

IV. Provider business mailing address

401 ESTUDILLO AVE STE 100
SAN LEANDRO CA
94577
US

V. Phone/Fax

Practice location:
  • Phone: 408-807-6787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: