Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | UO7211 | FL |
Y | 111NI0900X | Internist | UO7211 | FL |
NPI | 1003443698 |
---|---|
Provider Name | Andrea V Rivero |
First Address | Jacksonville, FL 32224 |
Second Address | Jacksonville, FL 32224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2020 |
Last Update Date | 02/09/2020 |