Healthcare Provider Details

I. General information

NPI: 1376734749
Provider Name (Legal Business Name): ITZA M RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ITZA M RIVERA VELAZQUEZ MD

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 CONROY RD STE 410
ORLANDO FL
32835-3567
US

IV. Provider business mailing address

11954 NARCOOSSEE RD STE 2-223
ORLANDO FL
32832-6998
US

V. Phone/Fax

Practice location:
  • Phone: 407-604-7053
  • Fax: 407-550-3763
Mailing address:
  • Phone: 407-604-7053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number17530
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME134558
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME134558
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number17530
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: