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General NPI Number Information
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NPI Number | 1306053129
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Entity Type | Individual
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Provider Name | PHILIP ANDREW RIVERA LPN
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5901 ZUNI RD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-3073
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Country | US
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Telephone | 505-841-8978
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Fax | 505-841-8974
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Provider Business Mailing Address
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Address Line | 6008 NORTHLAND AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2643
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Country | US
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Telephone | 505-837-1655
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | L10572
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License Number State | NM
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