Provider Demographics
NPI:1235587833
Name:RIVERON, CARIDAD
Entity Type:Individual
Prefix:
First Name:CARIDAD
Middle Name:
Last Name:RIVERON
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 1:1116 E MOWRY DR APT 101
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-8169
Mailing Address - Country:US
Mailing Address - Phone:786-348-1650
Mailing Address - Fax:
Practice Address - Street 1:1116 E MOWRY DR APT 101
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-8169
Practice Address - Country:US
Practice Address - Phone:786-348-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other