Provider Demographics
NPI:1639699317
Name:ORTIZ RIVERO, KATIUSKA
Entity Type:Individual
Prefix:
First Name:KATIUSKA
Middle Name:
Last Name:ORTIZ RIVERO
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 1:9411 SW 4TH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2019
Mailing Address - Country:US
Mailing Address - Phone:786-370-2195
Mailing Address - Fax:
Practice Address - Street 1:9411 SW 4TH ST APT 302
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2019
Practice Address - Country:US
Practice Address - Phone:786-370-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty