Provider Demographics
NPI:1689964819
Name:RIVAS, ALONZO (PA)
Entity Type:Individual
Prefix:
First Name:ALONZO
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2621 RIDGEPOINT DR
Mailing Address - Street 2:STE 130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5232
Mailing Address - Country:US
Mailing Address - Phone:512-583-9679
Mailing Address - Fax:512-334-2321
Practice Address - Street 1:2410 E RIVERSIDE DR
Practice Address - Street 2:STE G-3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3083
Practice Address - Country:US
Practice Address - Phone:512-744-6000
Practice Address - Fax:512-448-3776
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA07012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant