1629706411 NPI number — CIEL CHIQUEYI QUIAHUITL RIVAS MSW

Table of content: CIEL CHIQUEYI QUIAHUITL RIVAS MSW (NPI 1629706411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629706411 NPI number — CIEL CHIQUEYI QUIAHUITL RIVAS MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVAS
Provider First Name:
CIEL
Provider Middle Name:
CHIQUEYI QUIAHUITL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVAS
Provider Other First Name:
SANDRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629706411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8945 GOLF LINKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94605-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-317-1444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9650 ZELZAH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-993-9311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  110062 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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