RIVIERA PLAZA MEDICAL OFFICE LLC NPI 1013338144

NPI Information

  • NPI: 1013338144
  • Provider Name: RIVIERA PLAZA MEDICAL OFFICE LLC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Address: 1702 RIDGEWOOD AVE
    SUITE I
    HOLLY HILL, FL
    ZIP 32117
  • Phone: (386) 677-5415

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NPI Details

RIVIERA PLAZA MEDICAL OFFICE LLC is a primary care clinic center in Holly Hill, FL. RIVIERA PLAZA MEDICAL OFFICE LLC NPI is 1013338144. The provider is registered as an organization entity type.

The provider's business location address is:

1702 RIDGEWOOD AVE
SUITE I
HOLLY HILL, FL
ZIP 32117-416
Phone: (386) 677-5415
Fax: (386) 677-1475

The provider's authorized official is Gloria Helen Mikula .
The authorized official title is Medical Director and has the following contact phone number (386) 677-5415.

The enumeration date for this NPI number is 12/16/2013 and was last updated on 4/23/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareME47765FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1042193600MEDICAIDFLORIDA
2D50685MEDICARE UPINFLORIDA
3HS776AOTHERFLORIDAMEDICARE PTAN
402936MEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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