Healthcare Provider Details

I. General information

NPI: 1356420434
Provider Name (Legal Business Name): SANDRA RIVERA-LUCIANO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

PO BOX 557367
MIAMI FL
33255
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-6511
  • Fax: 305-662-8291
Mailing address:
  • Phone: 786-624-5845
  • Fax: 786-624-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME62401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: