=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396946828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMON LUIS RIVERA-OLIVIERI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 07/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 SW 84TH AVE SUITE B.
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-2731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-424-9300
-----------------------------------------------------
Fax | 954-424-3315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7601 NW 42ND PL APT 101
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-6252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-770-0339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME 82720
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------