Provider Demographics
NPI:1093090938
Name:RIVERO, JORGE E (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:E
Last Name:RIVERO
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:MR
Other - First Name:JORGE
Other - Middle Name:E
Other - Last Name:RIVERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SURGICAL ASSISTANT
Mailing Address - Street 1:755 BELLE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4543
Mailing Address - Country:US
Mailing Address - Phone:561-531-7914
Mailing Address - Fax:
Practice Address - Street 1:755 BELLE GROVE LN
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4543
Practice Address - Country:US
Practice Address - Phone:561-531-7914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical