Basic Information
| Provider Information | |||||||||
| NPI: | 1669709846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVAS | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | MAURICIO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 33RD AVE S # MS 21110Q | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554254516 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 15111 TWELVE OAKS CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MINNETONKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553055201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529934500 | ||||||||
| FaxNumber: | 9529934676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2009 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MT192772 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 53974 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.