Provider Demographics
NPI:1093237786
Name:RIVERA CARRERO, MELVIN DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:DANIEL
Last Name:RIVERA CARRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:321-758-2966
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:21 S CHARLES RICHARD BEALL BLVD
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-3332
Practice Address - Country:US
Practice Address - Phone:386-516-0930
Practice Address - Fax:386-668-6897
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR34654R207R00000X
PR33359207R00000X
FLME165828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine