Provider Demographics
NPI:1447206354
Name:RIVERA, RUTH M (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:M
Last Name:RIVERA
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 30997
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-0997
Mailing Address - Country:US
Mailing Address - Phone:561-310-5701
Mailing Address - Fax:
Practice Address - Street 1:BREVARD VA OPC
Practice Address - Street 2:2900 VETERANS WAY
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-637-3788
Practice Address - Fax:321-637-3648
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 012664-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry