Provider Demographics
NPI:1275658007
Name:RIVERA, PIIPAR S (PA-C)
Entity type:Individual
Prefix:
First Name:PIIPAR
Middle Name:S
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PIIPAR
Other - Middle Name:S
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2051 GREENHOUSE RD STE 270
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7573
Practice Address - Country:US
Practice Address - Phone:281-665-4444
Practice Address - Fax:281-392-6766
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB129383Medicare PIN
TXTXB129382Medicare PIN
TXTXB127765Medicare PIN