MEDICARE: RIVAS PRIMARY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1598402653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVAS PRIMARY CARE

Provider Business Mailing Address
First Line	:	PO BOX 14111
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88013-4111
Country	:	US
Telephone Number	:	915-213-4218
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 EXECUTIVE HILLS RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4724
Country	:	US
Telephone Number	:	806-283-5263
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. HUGO RIVAS
Credential	:	MD
Telephone Number	:	806-283-5263

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	05/19/2022

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