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General NPI Number Information
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NPI Number | 1245945195
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Entity Type | Individual
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Provider Name | ANDREA RIVAS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 2499 GLADES RD STE 105
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City | BOCA RATON
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State | FL
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Zip | 33431-7260
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Country | US
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Telephone | 561-350-1035
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Fax |
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Provider Business Mailing Address
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Address Line | 5320 NW 51ST ST
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3332
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Country | US
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Telephone | 754-264-2990
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9116694
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License Number State | FL
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