Provider Demographics
NPI:1154550887
Name:RIVAS, MILADYS M (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MILADYS
Middle Name:M
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MS, OTR/L
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Mailing Address - Street 1:625 FAIR OAKS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2694
Mailing Address - Country:US
Mailing Address - Phone:323-341-5580
Mailing Address - Fax:323-340-8298
Practice Address - Street 1:1111 W 6TH ST STE 111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1823
Practice Address - Country:US
Practice Address - Phone:323-404-1027
Practice Address - Fax:323-340-8298
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA10199225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist