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Contact Information

KENNETH RIVERA, PHYSICIAN ASSISTANT
104 W D. L. INGRAM AVE
CANNON AFB, NM88101
 Phone: 575-784-2778
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for KENNETH RIVERA · (Male)

NPI Number 1780399501
Status Active
Credentials PHYSICIAN ASSISTANT
Entity Individual
Enumeration date 01/16/2023
Last updated 03/08/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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