Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 9316286-1205 | UT |
Y | 111NI0900X | Internist | 9316286-1205 | UT |
N | 207RI0200X | Infectious Disease | 9316286-1205 | UT |
NPI | 1053668806 |
---|---|
Provider Name | Albert Rivero |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Provo, UT 84604-5569 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2012 |
Last Update Date | 02/10/2015 |