Provider Demographics
NPI:1619900610
Name:RIVES, ELVIRA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:J
Last Name:RIVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 COMMERCE WAY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-821-8861
Mailing Address - Fax:305-821-8783
Practice Address - Street 1:14505 COMMERCE WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-821-8861
Practice Address - Fax:305-821-8783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM0073603208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254703100Medicaid
G95307Medicare UPIN
FL43666Medicare ID - Type Unspecified