Basic Information
| Provider Information | |||||||||
| NPI: | 1720279011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA MUNDO | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | MARINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 GODWIN BLVD | ||||||||
| Address2: | FL 1 | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234348038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579344821 | ||||||||
| FaxNumber: | 7579344276 | ||||||||
| Practice Location | |||||||||
| Address1: | CEDAR CREST BLVD AND I-78 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104025369 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 03/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD439777 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD439777 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 0101252492 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101252492 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.