Provider Demographics
NPI:1326824905
Name:ESTEVE DE LA RIVA, POL
Entity Type:Individual
Prefix:
First Name:POL
Middle Name:
Last Name:ESTEVE DE LA RIVA
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 1:13425 SW 252ND WAY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-2590
Mailing Address - Country:US
Mailing Address - Phone:305-609-6173
Mailing Address - Fax:
Practice Address - Street 1:13425 SW 252ND WAY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-2590
Practice Address - Country:US
Practice Address - Phone:305-609-6173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician