Provider Demographics
NPI:1740691088
Name:RIVAS-OROZCO, VICKY YESENIA (MD)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:YESENIA
Last Name:RIVAS-OROZCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:YESENIA
Other - Last Name:RIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:680 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6738
Mailing Address - Country:US
Mailing Address - Phone:855-226-6633
Mailing Address - Fax:
Practice Address - Street 1:680 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6738
Practice Address - Country:US
Practice Address - Phone:855-226-6633
Practice Address - Fax:866-285-7068
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021927300Medicaid