Provider Demographics
NPI:1891441010
Name:ORTIZ RIVERA, ANIBAL JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:ANIBAL
Middle Name:JOSE
Last Name:ORTIZ RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:11531 SE US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-4429
Practice Address - Country:US
Practice Address - Phone:352-553-1669
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22628208D00000X
FLACN1680208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice