Provider Demographics
NPI:1710172093
Name:DOMICILLIARY SERVICE LLC
Entity Type:Organization
Organization Name:DOMICILLIARY SERVICE LLC
Other - Org Name:DR. RIVERO AND ASSOCIATES II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-595-9475
Mailing Address - Street 1:1513 VICEROY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2303
Mailing Address - Country:US
Mailing Address - Phone:469-685-7020
Mailing Address - Fax:214-920-8446
Practice Address - Street 1:1513 VICEROY DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2303
Practice Address - Country:US
Practice Address - Phone:469-685-7020
Practice Address - Fax:214-920-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO1083OtherRAILROAD MEDICARE PTAN
TX=========OtherGROUP/CORP TAX ID
DO1083OtherRAILROAD MEDICARE PTAN