| Organization Name: | RIVIERA PLAZA MEDICAL OFFICE LLC |
| NPI Number: | 1013338144 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GLORIA HELEN MIKULA (MEDICAL DIRECTOR) |
| Mailing Address: | 1702 Ridgewood Ave Suite I Holly Hill |
| State: | FL US |
| Postal Code: | 321175416 |
| Phone Number: | 3866775415 |
| Fax Number: | 3866771475 |
| NPI Enumeration Date: | 12/16/2013 |
| NPI Last Update Date: | 04/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | ME47765 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |