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General NPI Number Information
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NPI Number | 1346884806
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Entity Type | Individual
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Provider Name | JUSTIN GUY RIVERA PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 6841 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78216-7202
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Country | US
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Telephone | 210-901-6743
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Fax |
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Provider Business Mailing Address
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Address Line | 8107 SILVER HAMPTON
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City | SAN ANTONIO
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State | TX
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Zip | 78254-2805
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Country | US
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Telephone | 951-990-0268
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA57420
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | PA14175
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA14175
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License Number State | TX
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