Provider Demographics
NPI:1265667331
Name:RIVERA-DIAZ, ALBA DAMARIS (MD, LND)
Entity type:Individual
Prefix:DR
First Name:ALBA
Middle Name:DAMARIS
Last Name:RIVERA-DIAZ
Suffix:
Gender:F
Credentials:MD, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 KARRER TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7678
Mailing Address - Country:US
Mailing Address - Phone:787-507-2831
Mailing Address - Fax:
Practice Address - Street 1:3480 POLYNESIAN ISLE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4654
Practice Address - Country:US
Practice Address - Phone:407-507-2615
Practice Address - Fax:407-507-2616
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163967207RC0200X, 207RP1001X, 207R00000X
PR21814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty