Provider Demographics
NPI:1699901850
Name:ANTONIO V. RIVERA, M.D., P.A.
Entity type:Organization
Organization Name:ANTONIO V. RIVERA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:V
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-689-5220
Mailing Address - Street 1:510 VONDERBURG DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5954
Mailing Address - Country:US
Mailing Address - Phone:813-689-5220
Mailing Address - Fax:813-681-8243
Practice Address - Street 1:510 VONDERBURG DR
Practice Address - Street 2:SUITE 306
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5954
Practice Address - Country:US
Practice Address - Phone:813-689-5220
Practice Address - Fax:813-681-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty