Provider Demographics
NPI:1326448325
Name:RIVERA, CARLOS
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 FUTURES DR
Mailing Address - Street 2:SUITE 104-105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9095
Mailing Address - Country:US
Mailing Address - Phone:844-743-6224
Mailing Address - Fax:
Practice Address - Street 1:7550 FUTURES DR
Practice Address - Street 2:SUITE 104-105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9095
Practice Address - Country:US
Practice Address - Phone:844-743-6224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator