Healthcare Provider Details

I. General information

NPI: 1629323308
Provider Name (Legal Business Name): RIVERO DIAGNOSTIC CTER-PLANTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 NW 4TH ST #202
PLANTATION FL
33317-2247
US

IV. Provider business mailing address

7050 NW 4TH ST #202
PLANTATION FL
33317-2247
US

V. Phone/Fax

Practice location:
  • Phone: 954-791-9729
  • Fax: 954-791-9724
Mailing address:
  • Phone: 954-791-9729
  • Fax: 954-791-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberJR24949000
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ELIESER LEON
Title or Position: OWNER
Credential:
Phone: 954-791-9729