Healthcare Provider Details

I. General information

NPI: 1548711344
Provider Name (Legal Business Name): DIGESTIVE & LIVER DISEASE CONSULTANTS OF SOUTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7369 SHERIDAN ST STE 300
HOLLYWOOD FL
33024-2776
US

IV. Provider business mailing address

7369 SHERIDAN ST STE 300
HOLLYWOOD FL
33024-2776
US

V. Phone/Fax

Practice location:
  • Phone: 954-451-5932
  • Fax: 954-947-4351
Mailing address:
  • Phone: 954-451-5932
  • Fax: 954-947-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME118726
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN MANUEL RIVAS
Title or Position: MEDICAL DIRECTOR /OWNER
Credential: MD
Phone: 954-451-5932