| Riverside Family & Lifestyle Medicine | |
|
428 Del Prado Blvd N Ste 103 Cape Coral FL 33909-2210 | |
| (239) 351-2044 | |
| (833) 975-0941 |
| Full Name | Riverside Family & Lifestyle Medicine |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 428 Del Prado Blvd N Ste 103, Cape Coral, Florida |
| Authorized Official Name and Position | Luis Barata (OWNER) |
| Authorized Official Contact | 2393512044 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Family & Lifestyle Medicine 428 Del Prado Blvd N Ste 103 Cape Coral FL 33909-2210 Ph: (239) 351-2044 | Riverside Family & Lifestyle Medicine 428 Del Prado Blvd N Ste 103 Cape Coral FL 33909-2210 Ph: (239) 351-2044 |
| NPI Number | 1255928040 |
|---|---|
| Provider Enumeration Date | 12/28/2020 |
| Last Update Date | 01/14/2021 |
| Medicare PECOS PAC ID | 7113332800 |
|---|---|
| Medicare Enrollment ID | O20210210000811 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255928040 | NPI | - | NPPES |
| Provider Name | Luis J Barata Hidalgo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811473226 PECOS PAC ID: 6002156692 Enrollment ID: I20190318002216 |
| Provider Name | Taymi Milagros Rival Castillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801465885 PECOS PAC ID: 0840687927 Enrollment ID: I20220419001850 |
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