Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO4203 | FL |
NPI | 1013407311 |
---|---|
Provider Name | Mrs. Eileen Rivero |
First Address | Fort Myers, FL 33919-3425 |
Second Address | Cape Coral, FL 33990-2712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 22/10/2021 |