Healthcare Provider Details

I. General information

NPI: 1770089237
Provider Name (Legal Business Name): MILDRED DILORIS RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 LITCHFIELD ST
TORRINGTON CT
06790-6600
US

IV. Provider business mailing address

540 LITCHFIELD ST
TORRINGTON CT
06790-6600
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-6666
  • Fax: 860-496-6783
Mailing address:
  • Phone: 860-496-6646
  • Fax: 860-496-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number068139
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68139
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: