Provider Demographics
NPI:1356459630
Name:RIVERA, CARLOS E (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:E
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 W FLAGLER ST STE 1H
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2069
Mailing Address - Country:US
Mailing Address - Phone:305-220-5191
Mailing Address - Fax:877-795-5172
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:STE 1H
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:305-220-5191
Practice Address - Fax:877-795-5172
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053431207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037589600Medicaid
E21449Medicare UPIN
FL07912Medicare PIN