Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME101221 | FL |
NPI | 1134395288 |
---|---|
Provider Name | Dr. Kenya Maria Rivas Velasquez |
First Address | Orlando, FL 32804-4659 |
Second Address | Orlando, FL 32804-4659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 09/10/2008 |