Healthcare Provider Details

I. General information

NPI: 1629045216
Provider Name (Legal Business Name): WILFREDO RIVERA-ORTIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 MANATEE AVE W
BRADENTON FL
34205-5432
US

IV. Provider business mailing address

700 8TH AVE W STE 101
PALMETTO FL
34221-4737
US

V. Phone/Fax

Practice location:
  • Phone: 941-714-7150
  • Fax: 941-741-3242
Mailing address:
  • Phone: 941-776-4008
  • Fax: 941-845-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME64315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: