Healthcare Provider Details

I. General information

NPI: 1114178019
Provider Name (Legal Business Name): MONICA RIVERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8637 PISA DR #10211
ORLANDO FL
32810-2170
US

IV. Provider business mailing address

PO BOX 941274
MAITLAND FL
32794-1274
US

V. Phone/Fax

Practice location:
  • Phone: 888-322-6432
  • Fax: 888-329-6432
Mailing address:
  • Phone: 888-322-6432
  • Fax: 888-329-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MONICA M RIVERA
Title or Position: PRESIDENT
Credential: CSFA
Phone: 888-322-6432