Provider Demographics
NPI:1275578726
Name:MORA RIVERA, DANIEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:MORA RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 E GRANT ST STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1668
Mailing Address - Country:US
Mailing Address - Phone:407-367-4706
Mailing Address - Fax:321-203-4606
Practice Address - Street 1:5540 E GRANT ST STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1668
Practice Address - Country:US
Practice Address - Phone:407-367-4706
Practice Address - Fax:321-203-4606
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276205600Medicaid
FLI40740Medicare UPIN
FLAB786ZMedicare PIN