Revae Rivera, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT6340 Issued in TX

Practice address

805 E Crockett St
Crystal City, TX 78839-2711

Phone

(830) 374-2341

Fax

(830) 374-8012

NPI assigned

Nov 16, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Crystal City Isd

  • Student Health Clinic/Center
  • Crystal City, TX
  • NPI 1093188690
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1669846549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 630",
            "city": "CRYSTAL CITY",
            "state": "TX",
            "postal_code": "788390630",
            "telephone_number": "903-504-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 E CROCKETT ST",
            "city": "CRYSTAL CITY",
            "state": "TX",
            "postal_code": "788392711",
            "telephone_number": "830-374-2341",
            "fax_number": "830-374-8012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "REVAE",
        "name_prefix": "Ms.",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-16",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT6340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria L Ortiz, LPC
• Lorenzo Ortiz, LPC
• Karen Louise Richardson, PT
• Antonio H. Rivera, M.D.
• Maria Elma Rivera, CNM, FNP
• Andrea Ann Rodriguez, LPC
• Mirella Rodriguez, LVN
• Vivek Singh, DDS
• Charmaine Mary Sulaica, NP
• The Children'S Clinic of Dimmit & Zavala

• Athletic Trainer in Crystal City, TX
• Providers in Crystal City, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.