Provider Demographics
NPI:1326924580
Name:RIVAS, MARISSA MARIE (PPS, MA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:MARIE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:PPS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 LINDA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3648
Mailing Address - Country:US
Mailing Address - Phone:559-797-2822
Mailing Address - Fax:
Practice Address - Street 1:1301 N A ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3516
Practice Address - Country:US
Practice Address - Phone:805-742-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool