Healthcare Provider Details

I. General information

NPI: 1992992432
Provider Name (Legal Business Name): MICHELLE Y. RIVERA-VEGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W GORE ST
ORLANDO FL
32806-1141
US

IV. Provider business mailing address

60 W GORE ST
ORLANDO FL
32806-1141
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-1182
  • Fax: 321-841-3305
Mailing address:
  • Phone: 321-843-1182
  • Fax: 321-841-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC167414
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME120252
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberC167414
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME165149
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME120252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: