1629045216 NPI number — WILFREDO RIVERA-ORTIZ M.D.

Table of content: WILFREDO RIVERA-ORTIZ M.D. (NPI 1629045216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629045216 NPI number — WILFREDO RIVERA-ORTIZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA-ORTIZ
Provider First Name:
WILFREDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1629045216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 8TH AVE W
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
PALMETTO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34221-4737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-776-4008
Provider Business Mailing Address Fax Number:
941-845-4963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2318 MANATEE AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34205-5432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-714-7150
Provider Business Practice Location Address Fax Number:
941-741-3242
Provider Enumeration Date:
03/02/2006

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: 207V00000X , with the licence number:  ME64315 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 373435800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 584178469 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00017941 . This is a "RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P102212 . This is a "FREEDOM HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00449 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00449 . This is a "UNIVERSAL MEDICARE MASTERPIECE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1755356 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 191968 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 23697 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 149290 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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