Provider Demographics
NPI:1386472462
Name:RIVAS, DIVINA ELENA (AA, BA)
Entity type:Individual
Prefix:MISS
First Name:DIVINA
Middle Name:ELENA
Last Name:RIVAS
Suffix:
Gender:F
Credentials:AA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25200 CARLOS BEE BLVD APT 361
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-1549
Mailing Address - Country:US
Mailing Address - Phone:831-210-4412
Mailing Address - Fax:
Practice Address - Street 1:3045 GROVE WAY
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6703
Practice Address - Country:US
Practice Address - Phone:510-688-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician