Provider Demographics
NPI:1578007597
Name:RIVERA PHYSICIAN PLLC
Entity Type:Organization
Organization Name:RIVERA PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-281-5943
Mailing Address - Street 1:4345 E ALISO CYN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5582
Mailing Address - Country:US
Mailing Address - Phone:602-281-5943
Mailing Address - Fax:
Practice Address - Street 1:4345 E ALISO CYN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5582
Practice Address - Country:US
Practice Address - Phone:602-281-5943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44459207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty