Provider Demographics
NPI:1457540825
Name:MUY-RIVERA, MARTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:MUY-RIVERA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SW 39TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4915
Mailing Address - Country:US
Mailing Address - Phone:425-264-2568
Mailing Address - Fax:425-264-2569
Practice Address - Street 1:500 SW 39TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4915
Practice Address - Country:US
Practice Address - Phone:425-264-2568
Practice Address - Fax:425-264-2569
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005323363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8869199Medicare PIN