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General NPI Number Information
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NPI Number | 1396935037
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Entity Type | Organization
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Legal Business Name | JUAN I RIVERA
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 315 E OLYMPIA AVE 111
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City | PUNTA GORDA
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State | FL
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Zip | 33950-3833
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Country | US
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Telephone | 941-639-1640
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Fax | 941-637-9808
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Provider Business Mailing Address
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Address Line | 315 E OLYMPIA AVE # 111
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City | PUNTA GORDA
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State | FL
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Zip | 33950-3833
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Country | US
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Telephone | 941-639-1640
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Fax | 941-637-9808
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Authorized Official
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Title or Position | OWNER
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Name | JUAN I RIVERA
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Credential | M.D.
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Telephone | 941-639-1640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME050857
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License Number State | FL
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