Healthcare Provider Details

I. General information

NPI: 1124968409
Provider Name (Legal Business Name): DAIMELYS MAURA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10924 NW 7TH ST APT 702
MIAMI FL
33172-7605
US

IV. Provider business mailing address

10924 NW 7TH ST APT 702 APT 702
MIAMI FL
33172-7605
US

V. Phone/Fax

Practice location:
  • Phone: 786-318-4617
  • Fax:
Mailing address:
  • Phone: 786-318-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11045969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: