Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO2416 | FL |
Y | 222Z00000X | Podiatrist | PO2416 | FL |
NPI | 1003893538 |
---|---|
Provider Name | Juan J Rivera |
First Address | Tampa, FL 33609-4168 |
Second Address | Tampa, FL 33609-4168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 30/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2700454 | UNITED HEALTHCARE (01) | FL |
65329 | BLUE CROSS BLUE SHIELD (01) | FL |
U48151 | (02) | FL |