Active NPI
Wilben Andy Lariviere, PA
- Medical Physician Assistant
- Mesa, AZ
National Provider Identifier
1154076933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1212-P.A.
- Practice address
- 2045 S Vineyard Ste 119
Mesa, AZ 85210-6890 - Phone
- (480) 300-4646
- Fax
- (480) 300-4646
- NPI assigned
- Feb 19, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1212-P.A. | PR | Primary |
Addresses
Primary practice location
2045 S Vineyard Ste 119
Mesa, AZ 85210-6890
Mailing address
2045 S Vineyard Ste 119
Mesa, AZ 85210-6890
Phone (480) 300-4646
Other practice location 1
8260 NE 2nd Ave
Miami, FL 33138-3808
Phone (305) 757-9555
Other practice location 2
333 W Thomas Rd Ste 208A
Phoenix, AZ 85013-4425
Phone (480) 300-4646
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1212-P.A. | PR | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hope Diabetes Center, LLC | Medical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1154076933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2045 S VINEYARD STE 119",
"city": "MESA",
"state": "AZ",
"postal_code": "852106890",
"telephone_number": "480-300-4646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2045 S VINEYARD STE 119",
"city": "MESA",
"state": "AZ",
"postal_code": "852106890",
"telephone_number": "480-300-4646",
"fax_number": "480-300-4646"
}
],
"practiceLocations": [
{
"address_1": "8260 NE 2nd Ave",
"address_purpose": "LOCATION",
"city": "Miami",
"state": "FL",
"postal_code": "331383808",
"country_code": "US",
"telephone_number": "305-757-9555",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "333 W Thomas Rd Ste 208A",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850134425",
"country_code": "US",
"telephone_number": "480-300-4646",
"fax_number": "480-210-5059",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LARIVIERE",
"first_name": "WILBEN",
"middle_name": "ANDY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-02-19",
"last_updated": "2025-09-11",
"certification_date": "2023-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PR",
"license": "1212-P.A.",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.