Kenneth Rivera, PHYSICIAN ASSISTANT

NPI #1780399501 in Cannon Afb, New Mexico

Provider Information

NPI Number: 1780399501
Entity Type: Individual
Name: Kenneth Rivera, PHYSICIAN ASSISTANT
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PHYSICIAN ASSISTANT
Enumeration Date: Jan 16, 2023
Last Updated: Mar 8, 2024

Practice Location

Address: 104 W D. L. INGRAM AVE
City: Cannon Afb
State: New Mexico
ZIP Code: 88101
Phone: (575) 784-2778

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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