Provider Demographics
NPI:1629045216
Name:RIVERA-ORTIZ, WILFREDO (MD)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:RIVERA-ORTIZ
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 1:700 8TH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4008
Mailing Address - Fax:941-845-4963
Practice Address - Street 1:2318 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5432
Practice Address - Country:US
Practice Address - Phone:941-714-7150
Practice Address - Fax:941-741-3242
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64315207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373435800Medicaid
FL584178469OtherTRICARE
FLP00017941OtherRAILROAD
FLP102212OtherFREEDOM HEALTH
FL00449OtherUNIVERSAL
FL00449OtherUNIVERSAL MEDICARE MASTERPIECE
FL1755356OtherMEDICARE COMPLETE
FL191968OtherAMERIGROUP
FL23697OtherBCBS
FL149290OtherWELLCARE
FL584178469OtherTRICARE
FL23697XMedicare ID - Type Unspecified