Provider Demographics
NPI:1700890811
Name:RIVERA-OCASIO, MARIBEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:RIVERA-OCASIO
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 1:17150 ROYAL PALM BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2333
Mailing Address - Country:US
Mailing Address - Phone:954-349-9920
Mailing Address - Fax:954-349-3150
Practice Address - Street 1:17150 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2333
Practice Address - Country:US
Practice Address - Phone:954-349-9920
Practice Address - Fax:954-349-3150
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070311208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250380800Medicaid
FLG37881Medicare UPIN