Provider Demographics
NPI:1538558895
Name:JAIRO ERNESTO RIVEROS
Entity type:Organization
Organization Name:JAIRO ERNESTO RIVEROS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCED PRACTICAL NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIRO
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:RIVEROS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:786-333-5433
Mailing Address - Street 1:8410 SW 150TH AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1419
Mailing Address - Country:US
Mailing Address - Phone:786-333-5433
Mailing Address - Fax:
Practice Address - Street 1:8410 SW 150TH AVE APT 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1419
Practice Address - Country:US
Practice Address - Phone:786-333-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5164421251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care