Healthcare Provider Details

I. General information

NPI: 1669206231
Provider Name (Legal Business Name): ALISSA MONIQUE RIVERA OLGUIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14674 W MOUNTAIN VIEW BLVD STE 210
SURPRISE AZ
85374-2708
US

IV. Provider business mailing address

PO BOX 8114
PHOENIX AZ
85066-8114
US

V. Phone/Fax

Practice location:
  • Phone: 623-546-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number313381
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: