Healthcare Provider Details

I. General information

NPI: 1477799674
Provider Name (Legal Business Name): CANDICE M RIVERA MENDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CANDICE RIVERA MD

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 06/02/2023
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2432 S FRENCH AVE
SANFORD FL
32771-4276
US

IV. Provider business mailing address

6675 WESTWOOD BLVD STE 475
ORLANDO FL
32821-6027
US

V. Phone/Fax

Practice location:
  • Phone: 407-768-4464
  • Fax: 407-878-0114
Mailing address:
  • Phone: 407-845-0330
  • Fax: 888-972-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19110
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1018
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: