Basic Information
| Provider Information | |||||||||
| NPI: | 1699041772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVAS RODRIGUEZ | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 844658 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752844658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009940371 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 MEDICAL PKWY STE 110 | ||||||||
| Address2: | |||||||||
| City: | LAKEWAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126540150 | ||||||||
| FaxNumber: | 5126540155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2012 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | R7580 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 143137 | 01 | CA | MEDICAL LICENSE | OTHER |