Provider Demographics
NPI:1992211072
Name:GARCIA RIVERO, MANUEL ALAIN
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ALAIN
Last Name:GARCIA RIVERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12608 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5114
Mailing Address - Country:US
Mailing Address - Phone:786-406-5379
Mailing Address - Fax:
Practice Address - Street 1:12608 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-5114
Practice Address - Country:US
Practice Address - Phone:786-406-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-74933106S00000X
CO0-20-11436106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician