Provider Demographics
NPI:1033992029
Name:RIVERA, DIEGO
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9423 FONTAINEBLEAU BLVD APT 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5504
Mailing Address - Country:US
Mailing Address - Phone:305-609-3260
Mailing Address - Fax:
Practice Address - Street 1:9423 FONTAINEBLEAU BLVD APT 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5504
Practice Address - Country:US
Practice Address - Phone:305-609-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-290706106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician