Provider Demographics
NPI:1821508938
Name:RIVERA, SAUL MORONI (PA)
Entity Type:Individual
Prefix:MR
First Name:SAUL
Middle Name:MORONI
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5622 S 41ST WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-9026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4338 W THOMAS RD
Practice Address - Street 2:173
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040
Practice Address - Country:US
Practice Address - Phone:602-429-2239
Practice Address - Fax:602-559-5436
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ6839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant