Provider Demographics
NPI:1144054156
Name:RIVERO FLORES, MARIA FERNANDA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:RIVERO FLORES
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 1:743 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3373
Mailing Address - Country:US
Mailing Address - Phone:407-300-7465
Mailing Address - Fax:
Practice Address - Street 1:7212 CURRY FORD RD BLDG 4
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5806
Practice Address - Country:US
Practice Address - Phone:407-574-8481
Practice Address - Fax:786-513-7805
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1148723106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician