Individual
KENNETH RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
104 W D. L. INGRAM AVE, CANNON AFB, NM 88101
(575) 784-2778
Mailing address
104 W D. L. INGRAM AVE, CANNON AFB, NM 88101
(575) 784-2778
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/16/2023
Last updated
03/08/2024
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