Provider Demographics
NPI:1043735384
Name:ISRAEL, RIVA (PA-C, MMS)
Entity type:Individual
Prefix:
First Name:RIVA
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 W THOMAS RD STE 360
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3367
Mailing Address - Country:US
Mailing Address - Phone:623-327-8200
Mailing Address - Fax:623-327-8201
Practice Address - Street 1:9305 W THOMAS RD STE 360
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3367
Practice Address - Country:US
Practice Address - Phone:623-327-8200
Practice Address - Fax:623-327-8201
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6842363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6842OtherARIZONA REGULATORY BOARD OF PHYSICIAN ASSISTANTS