Provider Demographics
NPI:1427150598
Name:RIVERA, CRISTOBAL N (PA-C)
Entity type:Individual
Prefix:
First Name:CRISTOBAL
Middle Name:N
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1380
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WV
Mailing Address - Zip Code:26807-1380
Mailing Address - Country:US
Mailing Address - Phone:304-263-0811
Mailing Address - Fax:304-358-3641
Practice Address - Street 1:91 PINE STREET
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807
Practice Address - Country:US
Practice Address - Phone:304-263-0811
Practice Address - Fax:304-358-3641
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01101363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2031563Medicare PIN
WV2031561Medicare PIN
WV2031564Medicare PIN
WV2031566Medicare PIN
WV2031565Medicare PIN
WV2031562Medicare PIN