Provider Demographics
NPI:1114138922
Name:RIVAS, MARIA ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA ELENA
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA ELENA
Other - Middle Name:
Other - Last Name:RIVAS-COUTANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1003 BURLEW BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1799
Mailing Address - Country:US
Mailing Address - Phone:270-683-6848
Mailing Address - Fax:270-685-4197
Practice Address - Street 1:1003 BURLEW BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1799
Practice Address - Country:US
Practice Address - Phone:270-683-6848
Practice Address - Fax:270-685-4197
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17820208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics