Provider Demographics
NPI:1962405043
Name:DRS RIVERA INC
Entity type:Organization
Organization Name:DRS RIVERA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-297-4070
Mailing Address - Street 1:PO BOX 932347
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0001
Mailing Address - Country:US
Mailing Address - Phone:513-891-2813
Mailing Address - Fax:513-891-1039
Practice Address - Street 1:4460 RED BANK RD
Practice Address - Street 2:STE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2172
Practice Address - Country:US
Practice Address - Phone:513-297-4070
Practice Address - Fax:513-297-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200970290 AMedicaid
OHCJ6438OtherRR MEDICARE
OH2962370Medicaid
KY65937740Medicaid
OH9320141Medicare PIN
OH2962370Medicaid