Individual
WILBEN ANDY LARIVIERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2045 S VINEYARD STE 119, MESA, AZ 85210-6890
(480) 300-4646
(480) 300-4646
Mailing address
2045 S VINEYARD STE 119, MESA, AZ 85210-6890
(480) 300-4646
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1212-P.A.
PR
Other
Enumeration date
02/19/2022
Last updated
09/11/2025
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