Provider Demographics
NPI:1205416831
Name:PRIM RIVERA, RAFAEL DAVID (DVM)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:DAVID
Last Name:PRIM RIVERA
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11951 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5007
Mailing Address - Country:US
Mailing Address - Phone:407-382-3818
Mailing Address - Fax:
Practice Address - Street 1:11951 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5007
Practice Address - Country:US
Practice Address - Phone:407-382-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVM16463374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician