Provider Demographics
NPI:1689226219
Name:PRIETO RIVERO, LIUDMILA
Entity Type:Individual
Prefix:
First Name:LIUDMILA
Middle Name:
Last Name:PRIETO 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 1:1705 SW 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1012
Mailing Address - Country:US
Mailing Address - Phone:786-318-9542
Mailing Address - Fax:
Practice Address - Street 1:9250 NW 36TH ST STE 420
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2775
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily