Provider Demographics
NPI:1629573639
Name:ALFARO-RIVAS, ITZEL
Entity Type:Individual
Prefix:
First Name:ITZEL
Middle Name:
Last Name:ALFARO-RIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E YUCCA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2372
Mailing Address - Country:US
Mailing Address - Phone:956-648-1298
Mailing Address - Fax:
Practice Address - Street 1:120 E. MILE 3 RD
Practice Address - Street 2:
Practice Address - City:PALMHURST
Practice Address - State:TX
Practice Address - Zip Code:78573-5070
Practice Address - Country:US
Practice Address - Phone:956-583-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67106183500000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program