Individual
DOMINIQUE BREANN RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7704 2ND ST NW, ALBUQUERQUE, NM 87107-6755
(505) 890-1458
Mailing address
4301 ATHERTON WAY NW, ALBUQUERQUE, NM 87120-1260
(505) 280-9586
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2023-0236
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/29/2021
Last updated
05/12/2025
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