Provider Demographics
NPI:1356304828
Name:RIVERA IRIZARRY, MIRIAM L (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:L
Last Name:RIVERA IRIZARRY
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:PO BOX 582170
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-0027
Mailing Address - Country:US
Mailing Address - Phone:407-343-5000
Mailing Address - Fax:407-343-5199
Practice Address - Street 1:339 CYPRESS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3315
Practice Address - Country:US
Practice Address - Phone:407-343-5000
Practice Address - Fax:407-343-5199
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11914207R00000X
FLACN 295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3280OtherAMERICAN HEALTH
PR060075OtherCRUZ AZUL
PR1101838OtherACAA
FL002357600Medicaid
PR2968OtherINTERNATIONAL MEDICAL CAR
PR0400684OtherHUMANA HEALTH PLANS
PRMRI211OtherMENONITA
PR88490OtherTRIPLE S
PR212462OtherPREFERRED HEALTH
PR400294OtherMEDICARE Y MUCHO MAS
PR373955068OtherPROSAM
PR88490OtherTRIPLE S
PR400294OtherMEDICARE Y MUCHO MAS
PR060075OtherCRUZ AZUL