Healthcare Provider Details

I. General information

NPI: 1093237786
Provider Name (Legal Business Name): MELVIN DANIEL RIVERA CARRERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S CHARLES RICHARD BEALL BLVD
DEBARY FL
32713-3332
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 386-516-0930
  • Fax: 386-668-6897
Mailing address:
  • Phone: 321-758-2966
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34654R
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33359
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME165828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: