Provider Demographics
NPI:1447367891
Name:RIVERA, MARITZA H (MD)
Entity type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:H
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4850
Mailing Address - Country:US
Mailing Address - Phone:937-233-5824
Mailing Address - Fax:937-236-0935
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-267-5369
Practice Address - Fax:937-267-5316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7799261QV0200X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
Not Answered282N00000XHospitalsGeneral Acute Care Hospital