EDMUNDO I RIVERA MD PA
Psychiatric at Treemont Dr, Orange City, FL

License number
Florida ME62400
Category
Psychiatric
Type
Psychiatry
Owner
Name: DR. EDMUNDO I RIVERA MD
Title: MEDICAL DOCTOR
Phone: (386) 774-6001
Address
Address
250 Treemont Dr, Orange City, FL 32763
National Provider ID: 1477839306
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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EDMUNDO I. RIVERA, M.D., PA

Orange City, FL

Status:
Inactive
Inactive reason:
REINSTATEMENT
Registration:
May 13, 1997
Inactive since:
Dec 21, 1998
Addresses:
250 Treemonte St, Orange City, FL 32763 (Physical)
250 Treemont Dr, Orange City, FL 32763
296 Treemont Dr, Orange City, FL 32763
State ID:
P97000042286
Business type:
Florida Profit Corporation
Director:
Edmundo Im.d. Rivera (Director), 1700 Galway Ct, Winter Springs, FL 32708 (Physical)
Agent:
Edmundo Rivera
EIN:
59-3447915

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