MEDICARE: JESUS H RIVAS LMA

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	225700000X	Massage Therapist	MA 61994	FL

General Provider Information

NPI Number	:	1659651875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS H RIVAS LMA

Provider Business Mailing Address
First Line	:	7001 W 35TH AVE UNIT 245
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-7132
Country	:	US
Telephone Number	:	786-443-9628
Fax Number	:

Provider Business Practice Location Address
First Line	:	5168 SW 4TH ST
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-1257
Country	:	US
Telephone Number	:	786-226-3942
Fax Number	:

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

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	09/26/2011

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