Healthcare Provider Details

I. General information

NPI: 1871429506
Provider Name (Legal Business Name): ALEX DANIEL RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S RIDGE DR
CLEVELAND OH
44109-3756
US

IV. Provider business mailing address

416 S RIDGE DR
CLEVELAND OH
44109-3756
US

V. Phone/Fax

Practice location:
  • Phone: 216-544-4339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.499767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: