Provider Demographics
NPI:1295543288
Name:RIVERA MORALES, CRISTIAN DAVID I (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:DAVID
Last Name:RIVERA MORALES
Suffix:I
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CRISTIAN
Other - Middle Name:DAVID
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:127 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4326
Mailing Address - Country:US
Mailing Address - Phone:407-743-5089
Mailing Address - Fax:
Practice Address - Street 1:127 W FAIRBANKS AVE
Practice Address - Street 2:PMB # 526
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4326
Practice Address - Country:US
Practice Address - Phone:407-743-5089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11036841363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health