Provider Demographics
NPI:1902864333
Name:RIVERA, JOSE ARNALDO (DPM)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ARNALDO
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:PO BOX 403051
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-1051
Mailing Address - Country:US
Mailing Address - Phone:954-450-0099
Mailing Address - Fax:877-528-6642
Practice Address - Street 1:955 TOWN CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763
Practice Address - Country:US
Practice Address - Phone:386-218-4016
Practice Address - Fax:386-218-4107
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3038213ES0000X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217754501Medicaid
TXU95713Medicare UPIN
TXB107458OtherMEDICARE PROVIDER NUMBER