Provider Demographics
NPI:1144675364
Name:TORPOCO RIVERA, DIANA MILAGROS (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MILAGROS
Last Name:TORPOCO RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 BEAUBIEN BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-1892
Mailing Address - Fax:313-993-7118
Practice Address - Street 1:3901 BEAUBIEN BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1892
Practice Address - Fax:313-993-7118
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2023-05-17
Deactivation Date:2016-12-21
Deactivation Code:
Reactivation Date:2017-01-19
Provider Licenses
StateLicense IDTaxonomies
MI4301117226208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics