Provider Demographics
NPI:1275573495
Name:RIVERO, HOMERO G (MD)
Entity Type:Individual
Prefix:
First Name:HOMERO
Middle Name:G
Last Name:RIVERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14551 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3115
Mailing Address - Country:US
Mailing Address - Phone:305-228-8372
Mailing Address - Fax:305-264-9768
Practice Address - Street 1:7980 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6550
Practice Address - Country:US
Practice Address - Phone:305-264-9767
Practice Address - Fax:305-264-9768
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299455OtherAVMED
FL54312OtherNEIGHBORHOOD HEALTH
FL272128700Medicaid
FL272128700OtherMEDIPASS
FL30583OtherBC BS OF FLORIDA
FL30583OtherBC BS OF FLORIDA
FL143999Medicare UPIN