Provider Demographics
NPI:1164933503
Name:RIVAS, GINA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
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 1:4150 SILVER SPUR DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5157
Mailing Address - Country:US
Mailing Address - Phone:432-978-8844
Mailing Address - Fax:
Practice Address - Street 1:4150 SILVER SPUR DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-5157
Practice Address - Country:US
Practice Address - Phone:432-978-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant