Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A164066 | CA |
Y | 208600000X | Surgeon | A164066 | CA |
NPI | 1003173816 |
---|---|
Provider Name | Ray Herman Rivas |
First Address | Goleta, CA 93116-1206 |
Second Address | Santa Maria, CA 93454-5908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 01/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A164066 | MEDICAL BOARD OF CALIFORNIA (01) | CA |