Healthcare Provider Details

I. General information

NPI: 1164332482
Provider Name (Legal Business Name): ROBERTO ALEJANDRO RIVERA ORTIZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17740 BALI GROVE LOOP APT 207
WINTER GARDEN FL
34787-7765
US

IV. Provider business mailing address

17740 BALI GROVE LOOP APT 207
WINTER GARDEN FL
34787-7765
US

V. Phone/Fax

Practice location:
  • Phone: 352-531-4798
  • Fax:
Mailing address:
  • Phone: 352-531-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: