Provider Demographics
NPI:1699041772
Name:RIVAS RODRIGUEZ, ERICA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIA
Last Name:RIVAS RODRIGUEZ
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 1:2200 PARK BEND DR BLDG 1-200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5590
Mailing Address - Country:US
Mailing Address - Phone:512-637-0802
Mailing Address - Fax:512-717-6109
Practice Address - Street 1:2200 PARK BEND DR BLDG 1-200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5590
Practice Address - Country:US
Practice Address - Phone:512-637-0802
Practice Address - Fax:512-717-6109
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR75802084N0400X, 2084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA143137OtherMEDICAL LICENSE