Provider Demographics
NPI:1700464104
Name:RIVERA, REBECCA VALDEZ (NNP-BC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:VALDEZ
Last Name:RIVERA
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:VALDEZ
Other - Last Name:GENTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REBECCA VALDEZ
Mailing Address - Street 1:12338 WESTBURY AVE
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7157
Mailing Address - Country:US
Mailing Address - Phone:915-929-5058
Mailing Address - Fax:
Practice Address - Street 1:2001 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3320
Practice Address - Country:US
Practice Address - Phone:800-243-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX762551163WN0002X
TX1034355363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care