Provider Demographics
NPI:1992380323
Name:RIVERO MOYA, EDUARDO (RBT)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:RIVERO MOYA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 NELSON RD N
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-1410
Mailing Address - Country:US
Mailing Address - Phone:786-306-6321
Mailing Address - Fax:
Practice Address - Street 1:1405 NELSON RD N
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-1410
Practice Address - Country:US
Practice Address - Phone:786-306-6321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-124574106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty