Provider Demographics
NPI:1992777130
Name:RIVERA, DEBORAH ANN (PA-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:RIVERA
Suffix:
Gender:F
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 1:6801 JEFFERSON NEST 350
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4361
Mailing Address - Country:US
Mailing Address - Phone:505-884-8900
Mailing Address - Fax:888-699-4725
Practice Address - Street 1:6801 JEFFERSON NEST 350
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4361
Practice Address - Country:US
Practice Address - Phone:505-884-8900
Practice Address - Fax:888-699-4725
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2003-0031363A00000X
NMPA2003-003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPROVP15120OtherMOLINA
P00081095OtherRAILROAD MEDICARE
NM85324582Medicaid
AZ833104Medicaid
NM10005924OtherLOVELACE HEALTH/SALUD
NM201044362OtherPRESBYTERIAN HEALTH/SALUD
P00081095OtherRAILROAD MEDICARE
NM85324582Medicaid