Provider Demographics
NPI:1821153776
Name:HOMERO RIVERO MD PA
Entity Type:Organization
Organization Name:HOMERO RIVERO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOMERO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-264-9767
Mailing Address - Street 1:6741 CORAL WAY
Mailing Address - Street 2:STE 50 51
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1762
Mailing Address - Country:US
Mailing Address - Phone:305-264-9767
Mailing Address - Fax:305-264-9768
Practice Address - Street 1:6741 CORAL WAY
Practice Address - Street 2:STE 50 51
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1762
Practice Address - Country:US
Practice Address - Phone:305-264-9767
Practice Address - Fax:305-264-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30583OtherBCBS
FL272128700Medicaid
FL30583OtherBCBS