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NPI Code Detail

MEDICARE: MIRANDA MICHELLE RIVAS

MEDICARE: MIRANDA MICHELLE RIVAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1841496247
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA MICHELLE RIVAS
Provider Business Mailing Address
First Line : 3933 HARRISON ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-3523
Country : US
Telephone Number : 951-358-4328
Fax Number :
Provider Business Practice Location Address
First Line : 3933 HARRISON ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-3523
Country : US
Telephone Number : 951-358-4328
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2007
Last Update Date : 09/23/2015

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Directions to “ MIRANDA MICHELLE RIVAS ” Practice Location

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