Provider Demographics
NPI:1922004639
Name:RIASCOS, MARITZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:RIASCOS
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 1:315 E NASA BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1939
Mailing Address - Country:US
Mailing Address - Phone:321-733-2711
Mailing Address - Fax:321-733-2011
Practice Address - Street 1:1341 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3235
Practice Address - Country:US
Practice Address - Phone:321-733-2711
Practice Address - Fax:321-733-2011
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME902992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274608500Medicaid
FLI16706Medicare UPIN
FL274608500Medicaid