Healthcare Provider Details

I. General information

NPI: 1366401796
Provider Name (Legal Business Name): NASIM S DAVID RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N SEMORAN BLVD STE E
ORLANDO FL
32807-3562
US

IV. Provider business mailing address

719 E OAK ST
KISSIMMEE FL
34744-4580
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-8421
  • Fax: 407-823-8195
Mailing address:
  • Phone: 407-846-0533
  • Fax: 407-518-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME135709
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberACN835
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number8291
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: