Basic Information
Provider Information | |||||||||
NPI: | 1033428305 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RIVERA ONITIRI | ||||||||
FirstName: | ALEYDIS | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RIVERA-TORRES | ||||||||
OtherFirstName: | ALEYDIS | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 110 S WOODLAND ST | ||||||||
Address2: |   | ||||||||
City: | WINTER GARDEN | ||||||||
State: | FL | ||||||||
PostalCode: | 347873546 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4079058827 | ||||||||
FaxNumber: | 4079058998 | ||||||||
Practice Location | |||||||||
Address1: | 13275 W COLONIAL DR | ||||||||
Address2: |   | ||||||||
City: | WINTER GARDEN | ||||||||
State: | FL | ||||||||
PostalCode: | 34787 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4079058827 | ||||||||
FaxNumber: | 4076544079 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/04/2010 | ||||||||
LastUpdateDate: | 06/08/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ACN478 | FL | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 208D00000X | 18,032 | PR | N |   | Allopathic & Osteopathic Physicians | General Practice |   | 208D00000X | ACN478 | FL | Y |   | Allopathic & Osteopathic Physicians | General Practice |   |
ID Information
ID | Type | State | Issuer | Description | 009512200 | 05 | FL |   | MEDICAID |