Provider Demographics
NPI:1780686881
Name:RIVERA, MARIA-JOSEFINA SANTOS (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARIA-JOSEFINA
Middle Name:SANTOS
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:700 ZEALGLER DRIVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3860
Mailing Address - Country:US
Mailing Address - Phone:386-328-6746
Mailing Address - Fax:386-328-7554
Practice Address - Street 1:700 ZEALGLER DRIVE
Practice Address - Street 2:SUITE 10
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3860
Practice Address - Country:US
Practice Address - Phone:386-328-6746
Practice Address - Fax:386-328-7554
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76342207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080180322OtherRAILROAD MEDICARE
FL5237905OtherCCN
FL255175600Medicaid
FL43929OtherBLUECROSS/BLUESHIELD
FL2755931001OtherCIGNA
FL43929OtherBLUECROSS/BLUESHIELD
FL2755931001OtherCIGNA