MEDICARE: MRS. ELIZABETH A RIVERA CRNA

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	367500000X	Certified Registered Nurse Anesthetist	613549	TX

General Provider Information

NPI Number	:	1962593921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH A RIVERA CRNA

Provider Business Mailing Address
First Line	:	2727 TREBLE CRK APT 931
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4556
Country	:	US
Telephone Number	:	210-595-3018
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER SAN ANTONIO
Second Line	:	7703 FLOYD CURL DRIVE
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229
Country	:	US
Telephone Number	:	210-567-4500
Fax Number	:	210-567-0083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/29/2014

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