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NPI Code Detail

MEDICARE: DR. STEFANNY SANTANA RIVERA MD

MEDICARE: DR. STEFANNY SANTANA RIVERA MD
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
1207Q00000XFamily Medicine Physician35.148517OH
2207Q00000XFamily Medicine Physician61226KY

General Provider Information

NPI Number : 1104446020
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEFANNY SANTANA RIVERA MD
Provider Business Mailing Address
First Line : P.O. BOX 635283
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-5283
Country : US
Telephone Number : 859-344-5555
Fax Number : 859-344-5552
Provider Business Practice Location Address
First Line : 605 MAN O WAR BOULEVARD
Second Line :
City : UNION
State : KY
Zip : 41091-2007
Country : US
Telephone Number : 859-578-5333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2020
Last Update Date : 01/07/2026

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