Healthcare Provider Details

I. General information

NPI: 1063666907
Provider Name (Legal Business Name): MELBA L ORTIZ-RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 E ALTON GLOOR BLVD
BROWNSVILLE TX
78526-3831
US

IV. Provider business mailing address

1255 W WASHINGTON ST
MONTICELLO FL
32344-1128
US

V. Phone/Fax

Practice location:
  • Phone: 956-542-1956
  • Fax: 956-542-3672
Mailing address:
  • Phone: 850-342-0170
  • Fax: 850-342-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number25271
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN18510
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25271
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: