Provider Demographics
NPI:1225683865
Name:RIVERA PAVON, MAVI MAUREEN (MD)
Entity type:Individual
Prefix:
First Name:MAVI
Middle Name:MAUREEN
Last Name:RIVERA PAVON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAVI
Other - Middle Name:MAUREEN
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9101 KANIS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6455
Mailing Address - Country:US
Mailing Address - Phone:501-224-6366
Mailing Address - Fax:501-725-8445
Practice Address - Street 1:9101 KANIS RD STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6455
Practice Address - Country:US
Practice Address - Phone:501-224-6366
Practice Address - Fax:501-725-8445
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-17651207RR0500X
IL125074737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine