Healthcare Provider Details

I. General information

NPI: 1922990241
Provider Name (Legal Business Name): NORALYS ELIAN PAGAN RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date: 05/20/2026
Reactivation Date: 07/02/2026

III. Provider practice location address

636 DEL PRADO BLVD S
CAPE CORAL FL
33990-2668
US

IV. Provider business mailing address

708 DEL PRADO BLVD S STE 4
CAPE CORAL FL
33990-2676
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-2000
  • Fax:
Mailing address:
  • Phone: 239-424-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN45163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: