MEDICARE: DEBORAH ANN RIVERA PA-C

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA2003-0031	NM
2	363A00000X	Physician Assistant	PA2003-003	NM

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00081095	OTHER		RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PROVP15120	OTHER	NM	MOLINA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	10005924	OTHER	NM	LOVELACE HEALTH/SALUD
6	201044362	OTHER	NM	PRESBYTERIAN HEALTH/SALUD

NPI Number	:	1992777130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ANN RIVERA PA-C

Provider Business Mailing Address
First Line	:	6801 JEFFERSON NEST 350
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4361
Country	:	US
Telephone Number	:	505-884-8900
Fax Number	:	888-699-4725

Provider Business Practice Location Address
First Line	:	6801 JEFFERSON NEST 350
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4361
Country	:	US
Telephone Number	:	505-884-8900
Fax Number	:	888-699-4725

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	05/05/2021

4588 PARADISE BLVD NW , MEDICARE ADVANTAGE CLINIC
ALBUQUERQUE, NM
87114-4105

Practice Phone: 505-998-1840
Practice Fax: 505-998-1841