Provider Demographics
NPI:1972060135
Name:RIVAS-CANGAS, IRIS NOHEMI
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:NOHEMI
Last Name:RIVAS-CANGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 MELANIA MARTINEZ
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7513
Mailing Address - Country:US
Mailing Address - Phone:915-820-9573
Mailing Address - Fax:
Practice Address - Street 1:12800 EDGEMERE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4693
Practice Address - Country:US
Practice Address - Phone:905-504-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily