Healthcare Provider Details

I. General information

NPI: 1942880240
Provider Name (Legal Business Name): ALAN JAVIER RIVERA CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST
LUBBOCK TX
79430-0002
US

IV. Provider business mailing address

5629 DUKE ST
LUBBOCK TX
79416-1329
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-9945
  • Fax:
Mailing address:
  • Phone: 806-292-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: