Provider Demographics
NPI:1801833249
Name:RIVERA-RIOS, MARILIA (MD)
Entity Type:Individual
Prefix:
First Name:MARILIA
Middle Name:
Last Name:RIVERA-RIOS
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 1:12041 SW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1619
Mailing Address - Country:US
Mailing Address - Phone:954-809-5031
Mailing Address - Fax:
Practice Address - Street 1:12041 SW 32ND ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-1619
Practice Address - Country:US
Practice Address - Phone:954-809-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46724207P00000X
FLME111196207P00000X
IAMD-44206207P00000X
KY42709207P00000X
MI4302072392207P00000X
NMMD2008-0401207P00000X
PR007338207P00000X
WV26169207P00000X
TN27760207P00000X
OH35.122508207P00000X
MEMD19556207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4016617OtherBLUECROSS
TNP00254525OtherRAILROAD MEDICARE
TN3855458Medicaid
TN3855459Medicaid
TN4016614OtherBLUECROSS
E90938Medicare UPIN
TN3855459Medicaid
TN3855458Medicare PIN