Provider Demographics
NPI:1821044751
Name:RIVAS, ROSEMARY ROMO (APN)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:ROMO
Last Name:RIVAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 MCCULLOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4046
Mailing Address - Country:US
Mailing Address - Phone:210-225-5323
Mailing Address - Fax:210-225-7505
Practice Address - Street 1:1715 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4046
Practice Address - Country:US
Practice Address - Phone:210-225-5323
Practice Address - Fax:210-225-7505
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551810163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314283802OtherWELLMED MEDICAID
TXTXB166822OtherWELLMED MEDICARE