Provider Demographics
NPI:1992797377
Name:RIVERA-MORALES, ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:RIVERA-MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2840 PADDOCK RD
Mailing Address - Street 2:WINDMILL RANCH ESTATES
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3015
Mailing Address - Country:US
Mailing Address - Phone:954-389-1254
Mailing Address - Fax:954-389-4844
Practice Address - Street 1:2840 PADDOCK RD
Practice Address - Street 2:WINDMILL RANCH ESTATES
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3015
Practice Address - Country:US
Practice Address - Phone:954-389-1254
Practice Address - Fax:954-389-4844
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00359252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050571Medicaid
ID808641600Medicaid
PR72112Medicare ID - Type Unspecified
FL93968VMedicare PIN
FL93968CMedicare PIN
OH0050571Medicaid
ID808641600Medicaid
D64651Medicare UPIN