Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CA | |
N | 222Z00000X | Podiatrist | CA | |
N | 213E00000X | Podiatrist | CPO02952 | CA |
N | 222Z00000X | Podiatrist | CPO02952 | CA |
N | 224P00000X | Prosthetist | ||
N | 224P00000X | Prosthetist | CA | |
Y | 224P00000X | Prosthetist | CPO02952 | CA |
N | 225000000X | Orthotic Fitter | CP002624 | CA |
NPI | 1366630303 |
---|---|
Provider Name | Frank Edward Rivas |
First Address | San Francisco, CA 94160-0001 |
Second Address | Merced, CA 95348-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2007 |
Last Update Date | 11/05/2011 |