Provider Demographics
NPI:1568962280
Name:RIVERA, JOSE ELI (MS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ELI
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 INDIAN BLF
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1016
Mailing Address - Country:US
Mailing Address - Phone:610-587-9334
Mailing Address - Fax:
Practice Address - Street 1:11476 S APOPKA VINELAND RD # 118
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-7006
Practice Address - Country:US
Practice Address - Phone:407-955-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst