Healthcare Provider Details

I. General information

NPI: 1235016635
Provider Name (Legal Business Name): MAYRA CELESTE RIVAS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LAMOILLE HWY STE 103
ELKO NV
89801-4397
US

IV. Provider business mailing address

3240 SHIRLY LN
WINNEMUCCA NV
89445-8634
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-1292
  • Fax: 775-777-1293
Mailing address:
  • Phone: 775-294-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: