Provider Demographics
NPI:1336827443
Name:SAENZ RIVERA, SANDRA E (PA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:SAENZ RIVERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 S 82ND LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-7416
Mailing Address - Country:US
Mailing Address - Phone:602-554-6518
Mailing Address - Fax:
Practice Address - Street 1:2018 S 82ND LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-7416
Practice Address - Country:US
Practice Address - Phone:602-554-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001696-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical