Riviera Plaza Medical Office LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

ME47765 Issued in FL

Legal business name

RIVIERA PLAZA MEDICAL OFFICE LLC

Practice address

1702 Ridgewood Ave
Suite I
Holly Hill, FL 32117-5416

Phone

(386) 677-5415

Fax

(386) 677-1475

NPI assigned

Dec 16, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gloria Helen Mikula, MD

Title

Medical Director

Phone

(386) 677-5415

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398211200000",
    "number": "1013338144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 N HALIFAX AVE",
            "address_2": "SUITE1",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321184159",
            "telephone_number": "386-677-5415",
            "fax_number": "386-677-1475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 RIDGEWOOD AVE",
            "address_2": "SUITE I",
            "city": "HOLLY HILL",
            "state": "FL",
            "postal_code": "321175416",
            "telephone_number": "386-677-5415",
            "fax_number": "386-677-1475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVIERA PLAZA MEDICAL OFFICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-16",
        "last_updated": "2014-04-23",
        "status": "A",
        "authorized_official_last_name": "MIKULA",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_middle_name": "HELEN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "386-677-5415",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "ME47765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "042193600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "HS776A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Margarita Reekie, PTA
• Relief Chiropractic Rehabilitation Center
• Tiara Shawnte Richards
• Riddhinshiva Pharmacy LLC. (Community Pharmacy Daytona Beach)
• Linda Anne Rodgers, LMHC
• Robert W Sessoms, MD
• Deborah L Smith, LMT
• Kenneth W Smith, LMT
• SNH SE Holly Hill Tenant, LLC (Riviera Assisted Living Residences)

• Primary Care Clinic/Center in Holly Hill, FL
• Providers in Holly Hill, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.