Healthcare Provider Details

I. General information

NPI: 1801580428
Provider Name (Legal Business Name): CHRISTIAN RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE # 2346
STUART FL
34994-2346
US

IV. Provider business mailing address

200 SE HOSPITAL AVE # 2346
STUART FL
34994-2346
US

V. Phone/Fax

Practice location:
  • Phone: 787-287-5200
  • Fax:
Mailing address:
  • Phone: 727-287-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME176487
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.082464
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: