Healthcare Provider Details

I. General information

NPI: 1952213423
Provider Name (Legal Business Name): SHAIEN RIVERS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL CIR
WESTMINSTER CA
92683-3910
US

IV. Provider business mailing address

2158 BROOKWOOD AVE
SANTA ROSA CA
95404-7018
US

V. Phone/Fax

Practice location:
  • Phone: 657-666-7700
  • Fax:
Mailing address:
  • Phone: 707-210-6250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: