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NPI Code Detail

MEDICARE: ELBA RIVERA MA

MEDICARE: ELBA RIVERA MA
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1912395732
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELBA RIVERA MA
Provider Business Mailing Address
First Line : 1222 CONLEY ST
Second Line :
City : ORLANDO
State : FL
Zip : 32805-3116
Country : US
Telephone Number : 321-297-7098
Fax Number : 407-964-1274
Provider Business Practice Location Address
First Line : 6900 S ORANGE BLOSSOM TRL
Second Line : #402
City : ORLANDO
State : FL
Zip : 32809-5745
Country : US
Telephone Number : 407-382-9079
Fax Number : 407-964-1274
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2014
Last Update Date : 10/28/2015

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Directions to “ ELBA RIVERA MA” Practice Location

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