Provider Demographics
NPI:1295786093
Name:RIVERA, ROLANDO (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:RIVERA
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 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:1035 PIPER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110
Practice Address - Country:US
Practice Address - Phone:239-465-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93565208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274842800Medicaid
FL2128664OtherCIGNA
FLP01562648OtherRR MEDICARE
FLP01799067OtherCLEAR HEALTH ALLIANCE
FL1191282OtherWELLCARE
FL7693849OtherAETNA
FLP01214308OtherRAILROAD MCR
FLP306185OtherFREEDOM HEALTH
FL68392OtherBCBS OF FL
FLP306185OtherFREEDOM HEALTH
FL68392OtherBCBS OF FL
FL7693849OtherAETNA
FL10G250OtherHEALTHY KIDS
FL274842800Medicaid
FL1191282OtherWELLCARE