Provider Demographics
NPI:1962766980
Name:RIVADENEYRA PASTEN, HUGO ALEJANDRO (MD)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:ALEJANDRO
Last Name:RIVADENEYRA PASTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1215 DUFF AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4440
Mailing Address - Fax:515-239-4420
Practice Address - Street 1:1015 DUFF AVENUE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-4440
Practice Address - Fax:515-239-4420
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA44311207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism