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Individual

SANTOS MICHAEL RIVERA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
3463 MAGIC DR STE T21, SAN ANTONIO, TX 78229
(210) 614-8101
(210) 614-8102
Mailing address
3463 MAGIC DR STE T21, SAN ANTONIO, TX 78229-3621
(210) 614-8101
(210) 614-8102

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA01255
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
88N947
BCBS OF TEXAS
TX
Enumeration date
07/28/2006
Last updated
08/08/2019
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