Provider Demographics
NPI:1508259078
Name:RIVAS MEDICAL CENTERS GROUP
Entity Type:Organization
Organization Name:RIVAS MEDICAL CENTERS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-412-0478
Mailing Address - Street 1:11010 SW 88TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1216
Mailing Address - Country:US
Mailing Address - Phone:786-615-4868
Mailing Address - Fax:786-615-4850
Practice Address - Street 1:11010 SW 88TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1216
Practice Address - Country:US
Practice Address - Phone:786-615-4868
Practice Address - Fax:786-615-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center