Provider Demographics
NPI:1104453307
Name:RIVERO, ROSMEL
Entity type:Individual
Prefix:
First Name:ROSMEL
Middle Name:
Last Name:RIVERO
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 1:5451 TROPIC DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-4655
Mailing Address - Country:US
Mailing Address - Phone:727-678-2457
Mailing Address - Fax:
Practice Address - Street 1:5451 TROPIC DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-4655
Practice Address - Country:US
Practice Address - Phone:727-509-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR165730810990172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver