Healthcare Provider Details

I. General information

NPI: 1134395288
Provider Name (Legal Business Name): KENYA MARIA RIVAS VELASQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 235
ORLANDO FL
32804-4659
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 235
ORLANDO FL
32804-4659
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1967
  • Fax: 407-303-2517
Mailing address:
  • Phone: 407-303-1967
  • Fax: 407-303-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME101221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: