Provider Demographics
NPI:1558193441
Name:RIVELLO PODIATRY
Entity type:Organization
Organization Name:RIVELLO PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:ESCULLAR
Authorized Official - Last Name:LLOCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-360-3853
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:602-430-9057
Mailing Address - Fax:509-752-6544
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:602-430-9057
Practice Address - Fax:509-752-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty