Healthcare Provider Details

I. General information

NPI: 1427304732
Provider Name (Legal Business Name): DR. RACHEL MARIE LARIVEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 HIGH RESORT BLVD SE
RIO RANCHO NM
87124-5906
US

IV. Provider business mailing address

731 ASHLAND AVE APT 6
BUFFALO NY
14222-1178
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-6000
  • Fax: 505-462-8470
Mailing address:
  • Phone: 773-456-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2017-0181
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: