MEDICARE: DR. JOSE RIVAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME93735	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629166939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE RIVAS MD

Provider Business Mailing Address
First Line	:	1951 SW 172ND AVE STE 301
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-5614
Country	:	US
Telephone Number	:	954-510-5454
Fax Number	:	954-589-0960

Provider Business Practice Location Address
First Line	:	4420 SW 136TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3721
Country	:	US
Telephone Number	:	305-338-5046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	01/20/2022

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Directions to “ DR. JOSE RIVAS MD” Practice Location

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