MEDICARE: YUSIMI DE LA CARIDAD RIVERO PARDO DMD

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	1223G0001X	General Practice Dentistry	24421	FL

General Provider Information

NPI Number	:	1568024776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUSIMI DE LA CARIDAD RIVERO PARDO DMD

Provider Business Mailing Address
First Line	:	1922 NW 93RD TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6023
Country	:	US
Telephone Number	:	305-731-1987
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 NW 93RD TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6023
Country	:	US
Telephone Number	:	305-731-1987
Fax Number	:

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

Provider Enumeration Date	:	07/08/2019
Last Update Date	:	07/08/2019

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