Nydia Gricelle Deltoro Rivera, MD, WCC. DWC, CWS

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ACN634 Issued in FL

Practice address

1120 Carlton Ave
Lake Wales, FL 33853-4348

Phone

(863) 270-4546

NPI assigned

Nov 30, 2005

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• American Care of South Florida, Inc.

  • General Practice Physician
  • Miami, FL
  • NPI 1477754539
  Medicare reassignment
• American Care of South Florida, Inc.

  • General Practice Physician
  • Miami, FL
  • NPI 1093034100
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1679557912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12171 SW 268TH ST",
            "city": "HOMESTEAD",
            "state": "FL",
            "postal_code": "330328001",
            "telephone_number": "305-278-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 CARLTON AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534348",
            "telephone_number": "863-270-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELTORO RIVERA",
        "first_name": "NYDIA",
        "middle_name": "GRICELLE",
        "name_prefix": "Dr.",
        "credential": "MD, WCC. DWC, CWS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "13203",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elease Davis
• Geydi De la Pax Perez
• Victoria De Lissovoy, LCSW
• Yesenia Dejesus-Suarez, CRNA
• Delta Health Management, Inc
• Theresa Sunshine Delvalle, COTA
• Veronica E Diaz
• Marianne Dimetry, PHARMD
• Sentreila Collen Dinkens, RN
• Distinctive Dermatology PLLC

• General Practice Physician in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.