Provider Demographics
NPI:1245881028
Name:RIVERA MARCANO, ELVIN
Entity type:Individual
Prefix:
First Name:ELVIN
Middle Name:
Last Name:RIVERA MARCANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12536 TINSLEY CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7233
Mailing Address - Country:US
Mailing Address - Phone:813-613-9452
Mailing Address - Fax:
Practice Address - Street 1:12536 TINSLEY CIR APT 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7233
Practice Address - Country:US
Practice Address - Phone:813-613-9452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider