Healthcare Provider Details

I. General information

NPI: 1447367891
Provider Name (Legal Business Name): MARITZA H RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

6227 WELLINGTON PL
DAYTON OH
45424-4850
US

V. Phone/Fax

Practice location:
  • Phone: 937-267-5369
  • Fax: 937-267-5316
Mailing address:
  • Phone: 937-233-5824
  • Fax: 937-236-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number7799
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number7799
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: