Provider Demographics
NPI:1629323308
Name:RIVERO DIAGNOSTIC CTER-PLANTATION INC
Entity Type:Organization
Organization Name:RIVERO DIAGNOSTIC CTER-PLANTATION INC
Other - Org Name:RDC PLANTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIESER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-791-9729
Mailing Address - Street 1:7050 NW 4TH ST
Mailing Address - Street 2:#202
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2247
Mailing Address - Country:US
Mailing Address - Phone:954-791-9729
Mailing Address - Fax:954-791-9724
Practice Address - Street 1:7050 NW 4TH ST
Practice Address - Street 2:#202
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2247
Practice Address - Country:US
Practice Address - Phone:954-791-9729
Practice Address - Fax:954-791-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJR24949000261QR0200X
261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC9503OtherACHA