1356304828 NPI number — DR. MIRIAM L RIVERA IRIZARRY M.D.

Table of content: DR. MIRIAM L RIVERA IRIZARRY M.D. (NPI 1356304828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356304828 NPI number — DR. MIRIAM L RIVERA IRIZARRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA IRIZARRY
Provider First Name:
MIRIAM
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356304828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 582170
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34758-0027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-343-5000
Provider Business Mailing Address Fax Number:
407-343-5199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
339 CYPRESS PKWY STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34759-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-343-5000
Provider Business Practice Location Address Fax Number:
407-343-5199
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  11914 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ACN 295 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3280 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 060075 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1101838 . This is a "ACAA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 002357600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2968 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0400684 . This is a "HUMANA HEALTH PLANS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: MRI211 . This is a "MENONITA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 88490 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 212462 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400294 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 373955068 . This is a "PROSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 105884100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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