Individual
JOHAN ERNESTO RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3950 N A W GRIMES BLVD STE N201, ROUND ROCK, TX 78665-3540
(877) 800-5722
Mailing address
205 E UNIVERSITY AVE STE 200, GEORGETOWN, TX 78626-6821
(512) 994-1933
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA17137
TX
Other
Enumeration date
09/11/2023
Last updated
10/05/2023
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