Provider Demographics
NPI:1245433861
Name:RIVERA SOLER, IVAN A (MD)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:A
Last Name:RIVERA SOLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IVAN
Other - Middle Name:ANTONIO
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:51 N DOVERPLUM AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3308
Mailing Address - Country:US
Mailing Address - Phone:407-572-8862
Mailing Address - Fax:407-572-8863
Practice Address - Street 1:51 N DOVERPLUM AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3308
Practice Address - Country:US
Practice Address - Phone:407-572-8862
Practice Address - Fax:407-572-8863
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN241208D00000X
PR14883208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCO009XMedicare UPIN