Provider Demographics
NPI:1841737038
Name:ALTERNATIVE FAMILY MEDICINE
Entity Type:Organization
Organization Name:ALTERNATIVE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-687-7271
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:GOLDENROD
Mailing Address - State:FL
Mailing Address - Zip Code:32733-0084
Mailing Address - Country:US
Mailing Address - Phone:727-687-7271
Mailing Address - Fax:
Practice Address - Street 1:8000 RED BUG LAKE RD
Practice Address - Street 2:STE. 280
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9226
Practice Address - Country:US
Practice Address - Phone:727-687-7271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty