Healthcare Provider Details

I. General information

NPI: 1902864333
Provider Name (Legal Business Name): JOSE ARNALDO RIVERA D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 TOWN CENTER DR STE 200
ORANGE CITY FL
32763
US

IV. Provider business mailing address

PO BOX 403051
MIAMI BEACH FL
33140-1051
US

V. Phone/Fax

Practice location:
  • Phone: 386-218-4016
  • Fax: 386-218-4107
Mailing address:
  • Phone: 954-450-0099
  • Fax: 877-528-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO3038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: