Provider Demographics
NPI:1821233735
Name:RIVERA-CABAN, CARLOS MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MIGUEL
Last Name:RIVERA-CABAN
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 1:11373 CORTEZ BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5405
Mailing Address - Country:US
Mailing Address - Phone:352-597-0224
Mailing Address - Fax:352-597-0252
Practice Address - Street 1:11373 CORTEZ BLVD STE 208
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5405
Practice Address - Country:US
Practice Address - Phone:352-597-0224
Practice Address - Fax:352-597-0252
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1325282086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program