Healthcare Provider Details

I. General information

NPI: 1104864818
Provider Name (Legal Business Name): PATRICIA RIVAS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13975 MONO WAY STE I
SONORA CA
95370-2824
US

IV. Provider business mailing address

18933 RANCH RD
JAMESTOWN CA
95327-9155
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-9603
  • Fax: 209-533-9604
Mailing address:
  • Phone: 916-549-7449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: