Healthcare Provider Details

I. General information

NPI: 1043243660
Provider Name (Legal Business Name): RAUL RIVET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S SCHWARTZ AVE
FARMINGTON NM
87401-5955
US

IV. Provider business mailing address

PO BOX 15160
FARMINGTON NM
87401-5160
US

V. Phone/Fax

Practice location:
  • Phone: 505-564-8073
  • Fax: 505-324-2259
Mailing address:
  • Phone: 505-324-2258
  • Fax: 505-324-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number93-372
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: