Basic Information
| Provider Information | |||||||||
| NPI: | 1477916260 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RIVAS | ||||||||
| FirstName: | ESTEVAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15611 NEWKIRK RD | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799289046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152526173 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1660 COLUMBIA RD NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200093602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024694699 | ||||||||
| FaxNumber: | 2025488600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2016 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | DO034859 | DC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.