Healthcare Provider Details

I. General information

NPI: 1952178881
Provider Name (Legal Business Name): ANDILAY RIVERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 W 68TH ST # 127-128
HIALEAH FL
33016-5446
US

IV. Provider business mailing address

2750 W 68TH ST # 127-128
HIALEAH FL
33016-5446
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-0765
  • Fax: 305-558-0768
Mailing address:
  • Phone: 305-558-0765
  • Fax: 305-558-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: