Provider Demographics
NPI:1104622554
Name:RIVELLO WOUND CARE SPECIALISTS PC
Entity type:Organization
Organization Name:RIVELLO WOUND CARE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-542-6615
Mailing Address - Street 1:6737 W WREN AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8344
Mailing Address - Country:US
Mailing Address - Phone:760-542-6615
Mailing Address - Fax:
Practice Address - Street 1:6737 W WREN AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8344
Practice Address - Country:US
Practice Address - Phone:760-542-6615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty