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General NPI Number Information
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NPI Number | 1053133918
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Entity Type | Individual
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Provider Name | MA. CRISTINA DIVINA RIVILLA PTA
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 12665 GARDEN GROVE BLVD STE 603
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1920
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Country | US
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Telephone | 714-643-9012
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Fax | 714-643-9015
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Provider Business Mailing Address
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Address Line | 12771 CHELSEA CIR
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4109
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Country | US
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Telephone | 657-636-3499
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Fax | 714-643-9015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 53693
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License Number State | CA
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