Healthcare Provider Details

I. General information

NPI: 1497237689
Provider Name (Legal Business Name): PEDRO CENA RIVERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11255 SW 211TH ST
MIAMI FL
33189-2240
US

IV. Provider business mailing address

13951 SW 272ND ST
HOMESTEAD FL
33032-8895
US

V. Phone/Fax

Practice location:
  • Phone: 305-278-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1540
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: