MEDICARE: AGAVE FAMILY HEALTH, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4457	AZ

General Provider Information

NPI Number	:	1073719043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAVE FAMILY HEALTH, PLLC

Provider Business Mailing Address
First Line	:	3420 S MERCY RD
Second Line	:	113
City	:	GILBERT
State	:	AZ
Zip	:	85297-0419
Country	:	US
Telephone Number	:	480-219-3346
Fax Number	:	480-219-3652

Provider Business Practice Location Address
First Line	:	3420 S MERCY RD
Second Line	:	113
City	:	GILBERT
State	:	AZ
Zip	:	85297-0419
Country	:	US
Telephone Number	:	480-219-3346
Fax Number	:	480-219-3652

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOLLY FINLEY RIVIEZZO
Credential	:	DO
Telephone Number	:	480-219-3346

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	10/19/2007

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