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NPI Code Detail

MEDICARE: DR. KENYA MARIA RIVAS VELASQUEZ MD

MEDICARE: DR. KENYA MARIA RIVAS VELASQUEZ 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
1207QA0505XAdult Medicine PhysicianME101221FL

General Provider Information

NPI Number : 1134395288
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENYA MARIA RIVAS VELASQUEZ MD
Provider Business Mailing Address
First Line : 2501 N ORANGE AVE STE 235
Second Line :
City : ORLANDO
State : FL
Zip : 32804-4659
Country : US
Telephone Number : 407-303-1967
Fax Number : 407-303-2517
Provider Business Practice Location Address
First Line : 2501 N ORANGE AVE STE 235
Second Line :
City : ORLANDO
State : FL
Zip : 32804-4659
Country : US
Telephone Number : 407-303-1967
Fax Number : 407-303-2517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2008
Last Update Date : 10/09/2008

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