Provider Demographics
NPI:1447612155
Name:NIEVES RIVERA, CHRISTIAN ERICK (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ERICK
Last Name:NIEVES 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 1:92 W MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2032
Mailing Address - Country:US
Mailing Address - Phone:321-841-8588
Mailing Address - Fax:321-841-8560
Practice Address - Street 1:92 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2032
Practice Address - Country:US
Practice Address - Phone:321-841-8588
Practice Address - Fax:321-841-8560
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR019287208D00000X
FLME1692642080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL127494900Medicaid
PR019287Medicaid
PR019287Medicare UPIN
PR019287Medicaid
PR019287Medicare PIN