Provider Demographics
NPI:1003681446
Name:RIVERA, NIKOLE D
Entity Type:Individual
Prefix:MRS
First Name:NIKOLE
Middle Name:D
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14523 SW 144TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5683
Mailing Address - Country:US
Mailing Address - Phone:305-333-4196
Mailing Address - Fax:
Practice Address - Street 1:13973 SW 119TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6202
Practice Address - Country:US
Practice Address - Phone:305-414-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty