Provider Demographics
NPI:1144573981
Name:RIVERA, MIKE
Entity Type:Individual
Prefix:MR
First Name:MIKE
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 1:12360 SW 132ND CT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6464
Mailing Address - Country:US
Mailing Address - Phone:305-440-0922
Mailing Address - Fax:
Practice Address - Street 1:12360 SW 132ND CT
Practice Address - Street 2:SUITE 212
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6464
Practice Address - Country:US
Practice Address - Phone:305-440-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator