Provider Demographics
NPI:1437489630
Name:RIVAS, MARTHA ISABEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ISABEL
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:780 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2643
Mailing Address - Country:US
Mailing Address - Phone:954-412-7252
Mailing Address - Fax:954-467-4704
Practice Address - Street 1:2421 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2613
Practice Address - Country:US
Practice Address - Phone:954-412-7252
Practice Address - Fax:954-467-4704
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN340208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003235700Medicaid
FLFL779ZMedicare UPIN