Provider Demographics
NPI:1174662977
Name:RIVAS CAMPO, ALEJANDRO (MD,)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:RIVAS CAMPO
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE # LKSD5045
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-8751
Mailing Address - Fax:216-798-8925
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-8751
Practice Address - Fax:216-798-8925
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD48064207Y00000X
IN01070314A207YX0901X
FLME111331207YX0901X
VA0101250782207YX0901X
TN48064207YX0901X
OH35.139320207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology