Healthcare Provider Details

I. General information

NPI: 1962405043
Provider Name (Legal Business Name): DRS RIVERA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 RED BANK RD STE 200
CINCINNATI OH
45227-2172
US

IV. Provider business mailing address

PO BOX 932347
CLEVELAND OH
44193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-297-4070
  • Fax: 513-297-4070
Mailing address:
  • Phone: 513-891-2813
  • Fax: 513-891-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALFREDO RIVERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 513-297-4070