Provider Demographics
NPI:1720016827
Name:RIVERA, ORLANDO HERACLIO (DPM)
Entity Type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:HERACLIO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 KATY FWY STE 650
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2255
Mailing Address - Country:US
Mailing Address - Phone:713-691-9600
Mailing Address - Fax:713-692-9663
Practice Address - Street 1:5225 KATY FWY STE 650
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2255
Practice Address - Country:US
Practice Address - Phone:713-691-9600
Practice Address - Fax:713-692-9663
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1311213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
480032577OtherRAILROAD MEDICARE NUMBER
TX092853302Medicaid
TX1311OtherSTATE LICENSE NUMBER
TX4204540001Medicare NSC
8F0716Medicare PIN
480032577OtherRAILROAD MEDICARE NUMBER