Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME40201 | FL |
NPI | 1720256324 |
---|---|
Provider Name | Dr. Kenneth Rivera-Kolb |
First Address | Wilton Manors, FL 33305-1415 |
Second Address | Wilton Manors, FL 33305-1415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2008 |
Last Update Date | 25/03/2014 |