Provider Demographics
NPI:1386420552
Name:RIVAS, ALIA (APRN)
Entity type:Individual
Prefix:
First Name:ALIA
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WALKER PLACE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-4025
Mailing Address - Country:US
Mailing Address - Phone:512-556-3621
Mailing Address - Fax:
Practice Address - Street 1:2401 WALKER PLACE BLVD
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-4025
Practice Address - Country:US
Practice Address - Phone:254-547-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily