Healthcare Provider Details

I. General information

NPI: 1013667237
Provider Name (Legal Business Name): ALESKA P RIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15924 SW 92ND AVE BAY FL33157
MIAMI FL
33157-1842
US

IV. Provider business mailing address

10321 FAIRWAY HEIGHTS BLVD
MIAMI FL
33157-1558
US

V. Phone/Fax

Practice location:
  • Phone: 305-964-5824
  • Fax: 786-452-1200
Mailing address:
  • Phone: 786-728-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: