Basic Information
| Provider Information | |||||||||
| NPI: | 1760878219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVARA | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 N CENTRAL AVE STE 1001 | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122716 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 W THOMAS RD STE 720AND | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063715 | ||||||||
| FaxNumber: | 6024064011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2015 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 61138 | AZ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.