Healthcare Provider Details

I. General information

NPI: 1669432209
Provider Name (Legal Business Name): RAFAEL RIVERA-RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 BROOK AVE
WICHITA FALLS TX
76301-5602
US

IV. Provider business mailing address

1208 BROOK AVE
WICHITA FALLS TX
76301-5602
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-4480
  • Fax: 940-322-8420
Mailing address:
  • Phone: 940-322-4480
  • Fax: 940-322-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberJ3890
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberJ3890
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: