Provider Demographics
NPI:1124782263
Name:RIVERA, ULDA ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:ULDA
Middle Name:ELIZABETH
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:4700 MILLENIA BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6013
Mailing Address - Country:US
Mailing Address - Phone:407-533-6836
Mailing Address - Fax:407-232-9316
Practice Address - Street 1:2070 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6948
Practice Address - Country:US
Practice Address - Phone:602-834-9071
Practice Address - Fax:877-541-4239
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2023-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ8636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant