Provider Demographics
NPI:1316139959
Name:RIVERA, MIGUEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MIGUEL
Other - Middle Name:A
Other - Last Name:RIVERA-VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1285 36TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6587
Mailing Address - Country:US
Mailing Address - Phone:772-778-2009
Mailing Address - Fax:772-778-2910
Practice Address - Street 1:1986 35TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2533
Practice Address - Country:US
Practice Address - Phone:772-360-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1098412081P2900X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine