Provider Demographics
NPI:1174258933
Name:RIVERA, ZULAY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ZULAY
Middle Name:MARIE
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 1:5123 MINA CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7854
Mailing Address - Country:US
Mailing Address - Phone:939-425-7642
Mailing Address - Fax:
Practice Address - Street 1:5123 MINA CIR APT 103
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7854
Practice Address - Country:US
Practice Address - Phone:939-425-7642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE36327390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHSE36327OtherFLORIDA DEPARTMENT OF HEALTH HOUSE PHYSICIAN