Provider Demographics
NPI:1639565955
Name:RIVERA RIVERA, RUBEN JOSE (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:JOSE
Last Name:RIVERA 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 1:1804 OAKLEY SEAVER DR STE F
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1925
Mailing Address - Country:US
Mailing Address - Phone:407-499-0755
Mailing Address - Fax:407-543-2564
Practice Address - Street 1:1804 OAKLEY SEAVER DR STE F
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1925
Practice Address - Country:US
Practice Address - Phone:407-499-0755
Practice Address - Fax:407-543-2564
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR223702081S0010X
FLME1550602081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine