Provider Demographics
NPI:1275658007
Name:RIVERA, PIIPAR S (PA)
Entity Type:Individual
Prefix:
First Name:PIIPAR
Middle Name:S
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PIIPAR
Other - Middle Name:S
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2950 CULLEN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3921
Mailing Address - Country:US
Mailing Address - Phone:281-412-6262
Mailing Address - Fax:281-412-6740
Practice Address - Street 1:2950 CULLEN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3921
Practice Address - Country:US
Practice Address - Phone:281-412-6262
Practice Address - Fax:281-412-6740
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB129383Medicare PIN
TXTXB129382Medicare PIN
TXTXB127765Medicare PIN