Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO 2506 | FL |
Y | 222Z00000X | Podiatrist | PO 2506 | FL |
NPI | 1043211691 |
---|---|
Provider Name | Dr. Evaristo Enrique Rivero |
First Address | Lake Placid, FL 33852-9603 |
Second Address | Lake Placid, FL 33852-9603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2005 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390277300 | (05) | FL |
U59056 | (02) |