Provider Demographics
NPI:1669206231
Name:RIVERA OLGUIN, ALISSA MONIQUE (FNP)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:MONIQUE
Last Name:RIVERA OLGUIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85066-8114
Mailing Address - Country:US
Mailing Address - Phone:480-432-2112
Mailing Address - Fax:602-279-5361
Practice Address - Street 1:PO BOX 8114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85066-8114
Practice Address - Country:US
Practice Address - Phone:480-432-2112
Practice Address - Fax:602-279-5361
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ313381363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner