Healthcare Provider Details

I. General information

NPI: 1821359183
Provider Name (Legal Business Name): APRIL M RIVERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. APRIL M LOPEZ

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 12/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4313
US

IV. Provider business mailing address

PO BOX 95590
ALBUQUERQUE NM
87199-5590
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-9478
  • Fax:
Mailing address:
  • Phone: 505-503-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2012-0016
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: