MEDICARE: DR. LIZZA IVETTE RIVERA D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN 21702	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053381988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIZZA IVETTE RIVERA D.M.D

Provider Business Mailing Address
First Line	:	4410 W 16TH AVE
Second Line	:	SUITE 52
City	:	HIALEAH
State	:	FL
Zip	:	33012-7100
Country	:	US
Telephone Number	:	305-825-9899
Fax Number	:	305-825-9858

Provider Business Practice Location Address
First Line	:	4410 W 16TH AVE
Second Line	:	SUITE 52
City	:	HIALEAH
State	:	FL
Zip	:	33012-7100
Country	:	US
Telephone Number	:	305-825-9899
Fax Number	:	305-825-9858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	01/03/2024

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