Provider Demographics
NPI:1578528311
Name:RIVA, DIGNA I (MD)
Entity Type:Individual
Prefix:
First Name:DIGNA
Middle Name:I
Last Name:RIVA
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 1:9838 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2313
Mailing Address - Country:US
Mailing Address - Phone:305-758-7878
Mailing Address - Fax:305-754-2574
Practice Address - Street 1:9838 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2313
Practice Address - Country:US
Practice Address - Phone:305-758-7878
Practice Address - Fax:305-754-2574
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272371900Medicaid
FL08879Medicare ID - Type Unspecified
FL272371900Medicaid