Healthcare Provider Details

I. General information

NPI: 1811081334
Provider Name (Legal Business Name): ALFREDO NICODEMUS RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/27/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 RED BANK RD STE 217
CINCINNATI OH
45227-1548
US

IV. Provider business mailing address

4760 RED BANK RD STE 217
CINCINNATI OH
45227-1548
US

V. Phone/Fax

Practice location:
  • Phone: 513-297-4070
  • Fax: 513-297-4070
Mailing address:
  • Phone: 513-297-4070
  • Fax: 513-297-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36592
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-068271
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number36592
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number35-068271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: