Provider Demographics
NPI:1093237786
Name:RIVERA CARRERO, MELVIN DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:DANIEL
Last Name:RIVERA CARRERO
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 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:321-758-2966
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:1130 S SEMORAN BLVD STE BANDC
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1457
Practice Address - Country:US
Practice Address - Phone:407-382-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34654R207R00000X
PR33359207R00000X
FLME165828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine