Provider Demographics
NPI:1417482043
Name:RIVERA RODRIGUEZ, MARIANA ALEJANDRA (MD)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:ALEJANDRA
Last Name:RIVERA RODRIGUEZ
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 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:701 W. MCNAB RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5351
Practice Address - Country:US
Practice Address - Phone:954-466-7077
Practice Address - Fax:855-252-2845
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157842207R00000X
NC2020-03337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine