Individual
RICHARD ALLEN RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
802 RIO GRANDE LN, CREEDE, CO 81130-9554
(719) 658-0929
(719) 658-3001
Mailing address
310 COUNTY ROAD 14, DEL NORTE, CO 81132-8719
(719) 657-2510
(719) 657-4106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
636
CO
363A00000X
Physician Assistant
Primary
PA04083
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07006364
—
CO
Enumeration date
06/13/2006
Last updated
12/07/2022
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