Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | E7496 | TX |
Y | 207RP1001X | Pulmonary Disease | E7496 | TX |
NPI | 1083642037 |
---|---|
Provider Name | Manuel Rivera |
First Address | El Paso, TX 79995-9520 |
Second Address | El Paso, TX 79905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 11/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124209103 | (05) | TX |
B56078 | (02) | TX |
PH0009 | PTAN (01) | TX |