Individual
JESSICA PRADO RIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9250 COLLEGE PKWY STE 1, FORT MYERS, FL 33919-4847
(239) 256-1416
Mailing address
9250 COLLEGE PKWY STE 1, FORT MYERS, FL 33919-4847
(239) 256-1416
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
29397
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/14/2022
Last updated
07/16/2024
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