Provider Demographics
NPI:1265667331
Name:RIVERA-DIAZ, ALBA DAMARIS (MD, LND)
Entity type:Individual
Prefix:DR
First Name:ALBA
Middle Name:DAMARIS
Last Name:RIVERA-DIAZ
Suffix:
Gender:F
Credentials:MD, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:770 W GRANADA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5179
Mailing Address - Country:US
Mailing Address - Phone:386-231-4746
Mailing Address - Fax:386-368-8927
Practice Address - Street 1:1876 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4359
Practice Address - Country:US
Practice Address - Phone:352-742-4447
Practice Address - Fax:352-742-4447
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163967207R00000X, 207RC0200X, 207RP1001X
PR21814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty