Provider Demographics
NPI:1073588851
Name:RIVERA, JOSE RAMON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RAMON
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6489
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2521
Mailing Address - Country:US
Mailing Address - Phone:928-446-8353
Mailing Address - Fax:928-344-3434
Practice Address - Street 1:2281 W 24TH ST
Practice Address - Street 2:SUITE #2
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6154
Practice Address - Country:US
Practice Address - Phone:928-344-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant