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General NPI Number Information
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NPI Number | 1235943564
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Entity Type | Organization
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Legal Business Name | RIVERAS HEALTH & FARM LLC
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 16208 SEMINOLE BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34601-4324
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Country | US
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Telephone | 813-403-2601
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Fax |
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Provider Business Mailing Address
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Address Line | 10236 N VALLE DR
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City | TAMPA
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State | FL
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Zip | 33612-6571
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAGOBERTO RIVERA
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Credential |
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Telephone | 813-403-2601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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