Healthcare Provider Details

I. General information

NPI: 1104446020
Provider Name (Legal Business Name): STEFANNY SANTANA RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MAN O WAR BOULEVARD
UNION KY
41091-2007
US

IV. Provider business mailing address

P.O. BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-5333
  • Fax:
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.148517
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61226
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: