Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN 21702 | FL |
NPI | 1053381988 |
---|---|
Provider Name | Dr. Lizza Ivette Rivera |
First Address | Hialeah, FL 33012-7100 |
Second Address | Hialeah, FL 33012-7100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 03/03/2017 |