Healthcare Provider Details

I. General information

NPI: 1497273338
Provider Name (Legal Business Name): DORISSA R RIVERA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S MAYS ST STE 201
ROUND ROCK TX
78664-7580
US

IV. Provider business mailing address

101 W LOUIS HENNA BLVD STE 300
AUSTIN TX
78728-1203
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-4272
  • Fax: 512-244-2895
Mailing address:
  • Phone: 512-492-3743
  • Fax: 512-593-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0821095
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP136398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: