Provider Demographics
NPI:1811550148
Name:TAMEZE-RIVAS, FRANCK ALEX (MD, MBA)
Entity Type:Individual
Prefix:
First Name:FRANCK
Middle Name:ALEX
Last Name:TAMEZE-RIVAS
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LITTLE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301
Mailing Address - Country:US
Mailing Address - Phone:786-554-8640
Mailing Address - Fax:559-206-6308
Practice Address - Street 1:2300 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-523-1470
Practice Address - Fax:559-206-6308
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101272931207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program