Basic Information
Provider Information | |||||||||
NPI: | 1851730030 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JUARBE RIVERA | ||||||||
FirstName: | LESLIE | ||||||||
MiddleName: | ANNE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | JUARBE RIVERA | ||||||||
OtherFirstName: | LESLIE ANNE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 4685 FOREST AVE | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452123397 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5138534721 | ||||||||
FaxNumber: | 5138528525 | ||||||||
Practice Location | |||||||||
Address1: | 10500 MONTGOMERY RD | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 45242 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5138652246 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2013 | ||||||||
LastUpdateDate: | 08/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 309085 | LA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | D84581 | MD | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | ME137204 | FL | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207RC0200X | D84581 | MD | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | 309085 | LA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 2086S0102X | ME137204 | FL | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 207P00000X | 35.130828 | OH | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.