Provider Demographics
NPI:1659651875
Name:RIVAS, JESUS H (LMA)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:H
Last Name:RIVAS
Suffix:
Gender:M
Credentials:LMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 W 35TH AVE UNIT 245
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7132
Mailing Address - Country:US
Mailing Address - Phone:786-443-9628
Mailing Address - Fax:
Practice Address - Street 1:5168 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1257
Practice Address - Country:US
Practice Address - Phone:786-226-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 61994225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist