Individual
IVAN RISCO SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14736 SW 88 ST, MIAMI, FL 33196
(305) 387-3300
(305) 385-2870
Mailing address
14736 SW 88TH ST, MIAMI, FL 33196-1481
(305) 387-3300
(305) 385-2870
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
158211
FL
Other
Enumeration date
05/27/2014
Last updated
05/27/2014
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