Provider Demographics
NPI:1831186279
Name:RIVERA, ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
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:PO BOX 850001 DEPT 217
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0217
Mailing Address - Country:US
Mailing Address - Phone:941-345-1950
Mailing Address - Fax:941-345-1951
Practice Address - Street 1:4351 CORTEZ RD W STE 200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3217
Practice Address - Country:US
Practice Address - Phone:941-345-1950
Practice Address - Fax:941-345-1951
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79810207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260550300Medicaid
FL58025OtherBCBS
FL58025OtherBCBS
FL260550300Medicaid