Provider Demographics
NPI:1033428305
Name:RIVERA ONITIRI, ALEYDIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEYDIS
Middle Name:
Last Name:RIVERA ONITIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEYDIS
Other - Middle Name:
Other - Last Name:RIVERA-TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-905-8998
Practice Address - Street 1:13275 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-654-4079
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN478207Q00000X, 208D00000X
PR18,032208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009512200Medicaid