Healthcare Provider Details

I. General information

NPI: 1316139959
Provider Name (Legal Business Name): MIGUEL A RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MIGUEL A RIVERA-VELAZQUEZ M.D.

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1986 35TH AVE
VERO BEACH FL
32960-2533
US

IV. Provider business mailing address

1285 36TH ST STE 100
VERO BEACH FL
32960-6587
US

V. Phone/Fax

Practice location:
  • Phone: 772-360-4306
  • Fax:
Mailing address:
  • Phone: 772-778-2009
  • Fax: 772-778-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME109841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: