Provider Demographics
NPI:1154504546
Name:RIVERA, DAVID (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 PINE CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6500
Mailing Address - Country:US
Mailing Address - Phone:407-738-6230
Mailing Address - Fax:800-580-7167
Practice Address - Street 1:2452 PINE CHASE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6500
Practice Address - Country:US
Practice Address - Phone:407-738-6230
Practice Address - Fax:800-580-7167
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist