Healthcare Provider Details

I. General information

NPI: 1487115382
Provider Name (Legal Business Name): RIYA MOHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIYA JOB MD

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NW 4TH ST STE 104
PLANTATION FL
33317-2839
US

IV. Provider business mailing address

1841 NE 45TH ST
FORT LAUDERDALE FL
33308-5117
US

V. Phone/Fax

Practice location:
  • Phone: 954-820-4200
  • Fax:
Mailing address:
  • Phone: 954-820-4200
  • Fax: 954-678-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME171548
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME171548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: