MEDICARE: DR. MARIA P RIVAS-BONDAVALLI 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	390200000X	Student in an Organized Health Care Education/Training Program	TRN10295	FL
2	207N00000X	Dermatology Physician	ME104384	FL

General Provider Information

NPI Number	:	1871704858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA P RIVAS-BONDAVALLI M.D.

Provider Business Mailing Address
First Line	:	4770 BISCAYNE BLVD
Second Line	:	SUITE 1140
City	:	MIAMI
State	:	FL
Zip	:	33137-3202
Country	:	US
Telephone Number	:	305-573-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 BISCAYNE BLVD
Second Line	:	SUITE 1140
City	:	MIAMI
State	:	FL
Zip	:	33137-3202
Country	:	US
Telephone Number	:	305-573-7200
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	10/14/2014

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