Healthcare Provider Details

I. General information

NPI: 1639565955
Provider Name (Legal Business Name): RUBEN JOSE RIVERA RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 PORT ST JOHN PKWY
COCOA FL
32927-4305
US

IV. Provider business mailing address

8112 CENTRALIA CT STE 101
LEESBURG FL
34788-3701
US

V. Phone/Fax

Practice location:
  • Phone: 321-268-6868
  • Fax: 321-268-6196
Mailing address:
  • Phone: 352-251-2588
  • Fax: 407-930-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME155060
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number22370
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: