Provider Demographics
NPI:1598371064
Name:ORIVE PHYSICIAN SERVICES PA
Entity Type:Organization
Organization Name:ORIVE PHYSICIAN SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:MR
Authorized Official - First Name:YORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIVE GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-608-2991
Mailing Address - Street 1:6800 SW 40TH ST # 457
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3708
Mailing Address - Country:US
Mailing Address - Phone:786-608-2991
Mailing Address - Fax:
Practice Address - Street 1:6816 SW 89TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2430
Practice Address - Country:US
Practice Address - Phone:786-608-2991
Practice Address - Fax:786-894-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME143347Medicaid