Provider Demographics
NPI:1033113386
Name:RIVERO, ANGELINA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:A
Last Name:RIVERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 W HIGHWAY 243
Mailing Address - Street 2:STE 115
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1800
Mailing Address - Country:US
Mailing Address - Phone:972-932-3388
Mailing Address - Fax:972-932-2420
Practice Address - Street 1:874 W HIGHWAY 243
Practice Address - Street 2:STE 115
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1800
Practice Address - Country:US
Practice Address - Phone:972-932-3388
Practice Address - Fax:972-932-2420
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-04-01
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
TXF5014174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00140696OtherRAILROAD PTAN
TX130443802Medicaid
TX8K1074Medicare PIN
TX82T640Medicare PIN
TX00D80HMedicare ID - Type Unspecified
TX8L0012Medicare PIN
TXC21111Medicare UPIN
8F21983Medicare PIN