Provider Demographics
NPI:1275590929
Name:RIVERA-ORTIZ, EPIFANIO (MD)
Entity Type:Individual
Prefix:
First Name:EPIFANIO
Middle Name:
Last Name:RIVERA-ORTIZ
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 1:4917 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2166
Mailing Address - Country:US
Mailing Address - Phone:704-688-3861
Mailing Address - Fax:704-527-2329
Practice Address - Street 1:4221 TUCKASEEGEE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2801
Practice Address - Country:US
Practice Address - Phone:704-395-0060
Practice Address - Fax:704-527-2329
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900123146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
D99573Medicare UPIN