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General NPI Number Information
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NPI Number | 1487066312
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Entity Type | Individual
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Provider Name | IVAN RISCO SR.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 14736 SW 88 ST
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City | MIAMI
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State | FL
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Zip | 33196
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Country | US
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Telephone | 305-387-3300
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Fax | 305-385-2870
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Provider Business Mailing Address
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Address Line | 14736 SW 88TH ST
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City | MIAMI
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State | FL
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Zip | 33196-1481
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Country | US
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Telephone | 305-387-3300
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Fax | 305-385-2870
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | 158211
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License Number State | FL
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