Provider Demographics
NPI:1235795980
Name:RIVERA BLANCO, LIZ ENEIDA (MD)
Entity Type:Individual
Prefix:
First Name:LIZ ENEIDA
Middle Name:
Last Name:RIVERA BLANCO
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 1:105 ROGERS ST NE APT 3315
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1090
Mailing Address - Country:US
Mailing Address - Phone:787-502-5303
Mailing Address - Fax:
Practice Address - Street 1:105 ROGERS ST NE APT 3315
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1090
Practice Address - Country:US
Practice Address - Phone:787-502-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22260207P00000X
PR34105-R207P00000X
GA92336207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine