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General NPI Number Information
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NPI Number | 1477839306
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Entity Type | Organization
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Legal Business Name | EDMUNDO I RIVERA MD PA
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 250 TREEMONT DR
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City | ORANGE CITY
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State | FL
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Zip | 32763-7945
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Country | US
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Telephone | 386-774-6001
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Fax | 386-774-6044
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Provider Business Mailing Address
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Address Line | 250 TREEMONT DR
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City | ORANGE CITY
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State | FL
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Zip | 32763-7945
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Country | US
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Telephone | 386-774-6001
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Fax | 386-774-6044
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. EDMUNDO I RIVERA
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Credential | MD
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Telephone | 386-774-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME62400
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License Number State | FL
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