Provider Demographics
NPI:1801012109
Name:EUGENIO RIVERA DPM PA
Entity Type:Organization
Organization Name:EUGENIO RIVERA DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-441-7030
Mailing Address - Street 1:4343 W FLAGLER ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1586
Mailing Address - Country:US
Mailing Address - Phone:305-441-7030
Mailing Address - Fax:305-441-9484
Practice Address - Street 1:4343 W FLAGLER ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1586
Practice Address - Country:US
Practice Address - Phone:305-441-7030
Practice Address - Fax:305-441-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO32909213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340643100Medicaid
FL65582OtherBCBS
FLAD983Medicare PIN