Provider Demographics
NPI:1366401796
Name:DAVID RIVERA, NASIM S (MD)
Entity type:Individual
Prefix:DR
First Name:NASIM
Middle Name:S
Last Name:DAVID RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:719 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4580
Mailing Address - Country:US
Mailing Address - Phone:407-846-0533
Mailing Address - Fax:407-518-1730
Practice Address - Street 1:1400 N SEMORAN BLVD STE E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3562
Practice Address - Country:US
Practice Address - Phone:407-823-8421
Practice Address - Fax:407-823-8195
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1357092080A0000X
FLACN8352080A0000X
PR82912080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR99761OtherTRIPLE S
FLACN835OtherLICENSE
FLME135709OtherMEDICAL LICENSE
PR5313OtherFIRST MEDICAL