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Individual
LISA MARIE RIVERA
Active
Individual
LISA MARIE RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
8720
AZ
363A00000X
Physician Assistant
Primary
PA65595
CA
363AM0700X
Medical Physician Assistant
718429
TX
363AM0700X
Medical Physician Assistant
8720
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105817
—
AZ
01
—
PA65595
CALIFORNIA LICENSE
CA
Enumeration date
01/07/2021
Last updated
06/05/2025
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