MEDICARE: DR. AYMEE JARAMILLO RIVAS D.D.S

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	122300000X	Dentist	DN20454	FL

General Provider Information

NPI Number	:	1871841379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYMEE JARAMILLO RIVAS D.D.S

Provider Business Mailing Address
First Line	:	4621 SUNBEAM STATION CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5281
Country	:	US
Telephone Number	:	626-488-6546
Fax Number	:	904-503-7944

Provider Business Practice Location Address
First Line	:	9776 SAN JOSE BLVD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5464
Country	:	US
Telephone Number	:	904-475-2177
Fax Number	:	904-503-7944

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

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	01/30/2017

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