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General NPI Number Information
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NPI Number | 1689964819
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Entity Type | Individual
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Provider Name | ALONZO RIVAS PA
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Gender | Male
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 2410 E RIVERSIDE DR STE G-3
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City | AUSTIN
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State | TX
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Zip | 78741-3083
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Country | US
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Telephone | 512-744-6000
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Fax | 512-448-3776
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Provider Business Mailing Address
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Address Line | 2621 RIDGEPOINT DR STE 130
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City | AUSTIN
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State | TX
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Zip | 78754-5232
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Country | US
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Telephone | 512-583-9679
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Fax | 512-334-2321
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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 | PA07012
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License Number State | TX
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