Provider Demographics
NPI:1891984738
Name:RIVAS, MARTHA O (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:O
Last Name:RIVAS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 JERRY PATE PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4404
Mailing Address - Country:US
Mailing Address - Phone:915-591-5587
Mailing Address - Fax:
Practice Address - Street 1:1509 JERRY PATE PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4404
Practice Address - Country:US
Practice Address - Phone:915-591-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223891163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX223891OtherBOARD OF NURSE EXAMINERS
CNOR 077456OtherASSOC OPER ROOM NURSES