Provider Demographics
NPI:1871182311
Name:RIVERO FUENTES, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:RIVERO FUENTES
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 1:21584 SW 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6236
Mailing Address - Country:US
Mailing Address - Phone:786-797-6279
Mailing Address - Fax:
Practice Address - Street 1:20325 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1831
Practice Address - Country:US
Practice Address - Phone:786-592-1574
Practice Address - Fax:305-489-5972
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-62051106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician