Provider Demographics
NPI:1518554807
Name:RIVERA, LARIANA (TCM)
Entity Type:Individual
Prefix:
First Name:LARIANA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 S TEXAS AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-1816
Mailing Address - Country:US
Mailing Address - Phone:787-597-4513
Mailing Address - Fax:
Practice Address - Street 1:4701 S TEXAS AVE APT B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-1816
Practice Address - Country:US
Practice Address - Phone:787-597-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator