MEDICARE: RIVERA PAIN CONSULTANTS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1619522893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERA PAIN CONSULTANTS PLLC

Provider Business Mailing Address
First Line	:	5151 E PINCHOT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7910
Country	:	US
Telephone Number	:	949-723-9603
Fax Number	:	949-644-2377

Provider Business Practice Location Address
First Line	:	5151 E PINCHOT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7910
Country	:	US
Telephone Number	:	949-723-9603
Fax Number	:	949-209-3016

Authorized Official
Title or Position	:	STATUTORY AGENT
Name	:	DR. EDOUARD E RIVERA
Credential	:	MD
Telephone Number	:	949-723-9603

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/24/2021

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