Provider Demographics
NPI:1093974149
Name:RIVERO DIAGNOSTIC CENTER INC
Entity Type:Organization
Organization Name:RIVERO DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSNAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-281-7656
Mailing Address - Street 1:798 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1666
Mailing Address - Country:US
Mailing Address - Phone:786-281-7656
Mailing Address - Fax:305-698-0470
Practice Address - Street 1:285 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3713
Practice Address - Country:US
Practice Address - Phone:305-826-6040
Practice Address - Fax:305-698-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3740335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW9943Medicare PIN