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General NPI Number Information
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NPI Number | 1972291805
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Entity Type | Individual
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Provider Name | ALYSSA RIVERA CAA
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Gender | Female
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 1465 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1003
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Country | US
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Telephone | 314-577-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 40 FOREST LN
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City | TROY
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State | MO
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Zip | 63379-3817
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Country | US
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Telephone | 636-290-6463
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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