Healthcare Provider Details

I. General information

NPI: 1407247737
Provider Name (Legal Business Name): ELVIRA J. RIVES MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14505 COMMERCE WAY SUITE 800
MIAMI LAKES FL
33016-1597
US

IV. Provider business mailing address

14505 COMMERCE WAY SUITE 800
MIAMI LAKES FL
33016-1597
US

V. Phone/Fax

Practice location:
  • Phone: 305-821-8861
  • Fax: 305-821-8783
Mailing address:
  • Phone: 305-821-8861
  • Fax: 305-821-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME73603
License Number StateFL

VIII. Authorized Official

Name: DR. ELVIRA J RIVES
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 305-821-8861