Provider Demographics
NPI:1861493900
Name:RIVAS, DENCY (MD)
Entity type:Individual
Prefix:
First Name:DENCY
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7510
Mailing Address - Country:US
Mailing Address - Phone:813-628-4400
Mailing Address - Fax:813-628-4500
Practice Address - Street 1:7108 CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-6364
Practice Address - Country:US
Practice Address - Phone:813-628-4400
Practice Address - Fax:813-628-4500
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049004100Medicaid
FL049004100Medicaid
FLD21379Medicare UPIN