Provider Demographics
NPI:1235410044
Name:RIVAS, XYOMARA EMMA (MD)
Entity Type:Individual
Prefix:DR
First Name:XYOMARA
Middle Name:EMMA
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 N 19TH AVE STE 218
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2452
Mailing Address - Country:US
Mailing Address - Phone:602-413-0431
Mailing Address - Fax:602-314-4579
Practice Address - Street 1:5501 N 19TH AVE STE 218
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2452
Practice Address - Country:US
Practice Address - Phone:602-413-0431
Practice Address - Fax:602-314-4579
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28633R208000000X
AZ49634208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ944854Medicaid