Provider Demographics
NPI:1154510774
Name:RIVERA, KARELYS DIAZ (MD)
Entity Type:Individual
Prefix:
First Name:KARELYS
Middle Name:DIAZ
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 MICHEALANGELO
Mailing Address - Street 2:STE 102
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-1411
Mailing Address - Country:US
Mailing Address - Phone:956-686-6100
Mailing Address - Fax:
Practice Address - Street 1:2821 MICHEALANGELO
Practice Address - Street 2:STE 102
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1411
Practice Address - Country:US
Practice Address - Phone:956-686-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2928665Medicaid