Provider Demographics
NPI:1093414963
Name:MONTERO RIVERO, KARLA A
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:A
Last Name:MONTERO RIVERO
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 1:2851 NW 175TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4044
Mailing Address - Country:US
Mailing Address - Phone:786-702-0244
Mailing Address - Fax:
Practice Address - Street 1:11407 NW 7TH ST APT 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4946
Practice Address - Country:US
Practice Address - Phone:786-702-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23256799106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty