Provider Demographics
NPI:1518517408
Name:RIVERO, ISMAEL ALEX (RBT)
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:ALEX
Last Name:RIVERO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8964 NW 174TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6678
Mailing Address - Country:US
Mailing Address - Phone:786-557-9008
Mailing Address - Fax:
Practice Address - Street 1:8964 NW 174TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6678
Practice Address - Country:US
Practice Address - Phone:786-557-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-97802106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician