Provider Demographics
NPI:1427870476
Name:RIVERA, HERIBERTO (MSOM)
Entity type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11251 S ORANGE BLOSSOM TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9297
Mailing Address - Country:US
Mailing Address - Phone:407-501-6841
Mailing Address - Fax:407-542-2243
Practice Address - Street 1:11251 S ORANGE BLOSSOM TRL STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9297
Practice Address - Country:US
Practice Address - Phone:407-501-6841
Practice Address - Fax:407-542-2243
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach