Provider Demographics
NPI:1043892250
Name:RABARA, MICHELLE JOY SOLIVEN (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE JOY
Middle Name:SOLIVEN
Last Name:RABARA
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:286 S LENZNER AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5685
Mailing Address - Country:US
Mailing Address - Phone:520-452-0388
Mailing Address - Fax:877-281-8622
Practice Address - Street 1:1620 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2778
Practice Address - Country:US
Practice Address - Phone:520-459-0362
Practice Address - Fax:520-458-1585
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AZ8456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant