Provider Demographics
NPI:1801892245
Name:RIVERA-MORALES, RICARDO (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:RIVERA-MORALES
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 1:800 CENTURY MEDICAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2151
Mailing Address - Country:US
Mailing Address - Phone:321-269-5101
Mailing Address - Fax:321-269-6871
Practice Address - Street 1:800 CENTURY MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2151
Practice Address - Country:US
Practice Address - Phone:321-269-5101
Practice Address - Fax:321-269-6871
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070626207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264637400Medicaid
FL3371883OtherAETNA
FL58541OtherBCBS FLORIDA
FL58541OtherCHAMPUS/TRICARE FOR LIFE
FL193074OtherWELLCARE
FLP00066127OtherMEDICARE RAILROAD
FL193074OtherWELLCARE
FL264637400Medicaid