Healthcare Provider Details

I. General information

NPI: 1013407311
Provider Name (Legal Business Name): EILEEN RIVERO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 BOLADO PKWY
CAPE CORAL FL
33990-2712
US

IV. Provider business mailing address

1338 CHALON LN
FORT MYERS FL
33919-3425
US

V. Phone/Fax

Practice location:
  • Phone: 786-510-1819
  • Fax:
Mailing address:
  • Phone: 786-101-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO4203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: