Individual ProviderRaul RiveraPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7600 N 15th St Ste 100, Phoenix, AZ 85020-4330(602) 704-2345PECOS EnrollmentBased on the most recent information from CMS, provider Raul Rivera is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:51 AM.Profile DetailsProvider ID1326638172Provider TypeIndividualFull NameRivera, RaulCredentialPA-CGenderMaleSole ProprietorYesEnumeration Date1/25/2021Last Updated3/8/2022Contact InformationPractice LocationPractice Address7600 N 15th St Ste 100, Phoenix, AZ 85020-4330Phone(602) 704-2345Fax(602) 704-2399Mailing LocationMailing Address1 N 1st St Fl 7, Phoenix, AZ 85004-2357Phone(602) 704-2345Fax(602) 704-2399Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense8351ArizonaCode363AM0700XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense8351Arizona