Provider Demographics
NPI:1568297406
Name:RIVAS, MARILI SELENE
Entity type:Individual
Prefix:
First Name:MARILI
Middle Name:SELENE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 SUNWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-4164
Mailing Address - Country:US
Mailing Address - Phone:559-719-7143
Mailing Address - Fax:
Practice Address - Street 1:446 SUNWOOD ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-4164
Practice Address - Country:US
Practice Address - Phone:559-719-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician