Provider Demographics
NPI:1508301698
Name:RIVERO-VILLAVICENCIO, OLGALIDIA
Entity Type:Individual
Prefix:
First Name:OLGALIDIA
Middle Name:
Last Name:RIVERO-VILLAVICENCIO
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 1:13362 SW 43RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3935
Mailing Address - Country:US
Mailing Address - Phone:786-333-2687
Mailing Address - Fax:
Practice Address - Street 1:419 W 49TH ST
Practice Address - Street 2:STE 210
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3654
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician