MEDICARE: AGUSTIN RIVAS M.D.

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	208D00000X	General Practice Physician	ME100281	FL
2	208000000X	Pediatrics Physician	ME 100281	FL
3	174400000X	Specialist	ME100281	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205948783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGUSTIN RIVAS M.D.

Provider Business Mailing Address
First Line	:	255 WESTWARD DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5259
Country	:	US
Telephone Number	:	786-621-9777
Fax Number	:	786-621-9601

Provider Business Practice Location Address
First Line	:	255 WESTWARD DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5259
Country	:	US
Telephone Number	:	786-621-9777
Fax Number	:	786-621-9601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/07/2026

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