Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 54689 | KY |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 54689 | KY |
NPI | 1164884540 |
---|---|
Provider Name | Sebastian Rivera |
First Address | Chicago, IL 60677-6531 |
Second Address | Louisville, KY 40202-3905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2016 |
Last Update Date | 04/05/2021 |