=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275573495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOMERO G. RIVERO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 09/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7980 SW 24TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-6550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-264-9767
-----------------------------------------------------
Fax | 305-264-9768
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14551 SW 10TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33184-3115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-228-8372
-----------------------------------------------------
Fax | 305-264-9768
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME92032
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------