Provider Demographics
NPI:1841622305
Name:RIVERA, MAIZAL CUAUHTEMOC BENITO (FNP)
Entity type:Individual
Prefix:MR
First Name:MAIZAL
Middle Name:CUAUHTEMOC BENITO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5003 BAYONNE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-2526
Mailing Address - Country:US
Mailing Address - Phone:210-861-3721
Mailing Address - Fax:
Practice Address - Street 1:740 S ALAMO ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-3437
Practice Address - Country:US
Practice Address - Phone:210-222-0333
Practice Address - Fax:210-928-4837
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95028400363LF0000X
TX713678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily