Provider Demographics
NPI:1134395288
Name:RIVAS VELASQUEZ, KENYA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:KENYA
Middle Name:MARIA
Last Name:RIVAS VELASQUEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2501 N ORANGE AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4659
Mailing Address - Country:US
Mailing Address - Phone:407-303-1967
Mailing Address - Fax:407-303-2517
Practice Address - Street 1:2501 N ORANGE AVE STE 235
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4659
Practice Address - Country:US
Practice Address - Phone:407-303-1967
Practice Address - Fax:407-303-2517
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME101221207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine