Healthcare Provider Details

I. General information

NPI: 1922277789
Provider Name (Legal Business Name): JOHN RIVAS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 N YARBROUGH DR SUITE 101
EL PASO TX
79925-3165
US

IV. Provider business mailing address

11359 BEACH FRONT DR
EL PASO TX
79936-3807
US

V. Phone/Fax

Practice location:
  • Phone: 915-595-6461
  • Fax: 915-595-9901
Mailing address:
  • Phone: 915-588-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number59800
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: