Healthcare Provider Details

I. General information

NPI: 1184737157
Provider Name (Legal Business Name): DANIEL LUIS RIVAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 DARROW RD SUITE 106
HUDSON OH
44236-5026
US

IV. Provider business mailing address

5700 DARROW RD SUITE 106
HUDSON OH
44236-5026
US

V. Phone/Fax

Practice location:
  • Phone: 330-656-5911
  • Fax: 330-656-5901
Mailing address:
  • Phone: 330-656-5911
  • Fax: 330-656-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO 770
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO 770
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number010074
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number010074
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: