1033113386 NPI number — DR. ANGELINA A RIVERO MD

Table of content: DR. ANGELINA A RIVERO MD (NPI 1033113386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033113386 NPI number — DR. ANGELINA A RIVERO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERO
Provider First Name:
ANGELINA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033113386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2006
NPI Reactivation Date:
04/05/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
874 W HIGHWAY 243
Provider Second Line Business Mailing Address:
STE 115
Provider Business Mailing Address City Name:
KAUFMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75142-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-932-3388
Provider Business Mailing Address Fax Number:
972-932-2420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
874 W HIGHWAY 243
Provider Second Line Business Practice Location Address:
STE 115
Provider Business Practice Location Address City Name:
KAUFMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75142-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-932-3388
Provider Business Practice Location Address Fax Number:
972-932-2420
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  F5014 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00140696 . This is a "RAILROAD PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130443802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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