Provider Demographics
NPI:1215299060
Name:RIVERVIEW COSMETOGYNECOLOGY PLLC
Entity type:Organization
Organization Name:RIVERVIEW COSMETOGYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ-MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-547-4724
Mailing Address - Street 1:5908 BEDFORD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6605
Mailing Address - Country:US
Mailing Address - Phone:509-545-2118
Mailing Address - Fax:509-547-4881
Practice Address - Street 1:5908 BEDFORD ST
Practice Address - Street 2:SUITE D
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6605
Practice Address - Country:US
Practice Address - Phone:509-545-2118
Practice Address - Fax:509-547-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical