Provider Demographics
NPI:1477635449
Name:DEL RIESGO, VIVIAN LORENZO (MOT, OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:LORENZO
Last Name:DEL RIESGO
Suffix:
Gender:F
Credentials:MOT, OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4284 S. W. 161 PLACE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185
Mailing Address - Country:US
Mailing Address - Phone:786-208-2814
Mailing Address - Fax:305-228-6251
Practice Address - Street 1:4284 S. W. 161 PLACE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185
Practice Address - Country:US
Practice Address - Phone:786-208-2814
Practice Address - Fax:305-228-6251
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8340225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887057800Medicaid
FLU3118ZMedicare PIN