=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740426261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGELINA A. RIVERO, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2009
-----------------------------------------------------
Last Update Date | 10/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 874 ED HALL DR SUITE 115
-----------------------------------------------------
City | KAUFMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75142-1861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-932-3388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 874 ED HALL DR SUITE 115
-----------------------------------------------------
City | KAUFMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75142-1861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-932-3388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANGELINA A. RIVERO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 972-932-3388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | F5014
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------