Healthcare Provider Details

I. General information

NPI: 1154530368
Provider Name (Legal Business Name): ROWLAND J. RIVERO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S SHOOP AVE
WAUSEON OH
43567-1702
US

IV. Provider business mailing address

14040 MOHLER RD
LIBERTY CENTER OH
43532-9407
US

V. Phone/Fax

Practice location:
  • Phone: 419-330-2603
  • Fax:
Mailing address:
  • Phone: 419-509-6687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.007881
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34007881
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: